Cardiac & Respiratory Function Supported by Abdominal Muscles in Muscular Dystrophy

This study, reported in the Journal of Neuromuscular Diseases found that “abdominal muscles may be severely involved in the muscular dystrophy process. The abdominal muscles are important to provide respiratory support when the diaphragm muscle has been damaged by the disease, so that additional abdominal muscle involvement can worsen the respiratory situation considerably.”

“In MD where both breathing muscles and cardiac muscles are affected, this interdependence can lead to accelerated pathology. Normally, the diaphragm muscle drives about 50% of respiratory force, but other muscles provide the remainder. In MD, that balance is changed once the diaphragm becomes damaged. As the disease progresses, the abdominal muscles take over more of the respiratory function, but little is known about how the abdominal muscles themselves are affected by the progression of the disease, and whether these changes in abdominal muscle function correlate to underlying cardiopulmonary pathology.”

Lead investigator Elizabeth M. McNally, MD, PhD, Director, Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, discussed the implications for human muscular dystrophy, saying,

“Supporting and maintaining proper cardiopulmonary function in neuromuscular disease is a mainstay of therapy. Maintaining diaphragm health has been the focus of many studies in both humans and mice with muscular dystrophy, but few studies have focused on supporting and evaluating the accessory muscles of respiration such as the abdominal muscles. Therapies that spare or protect the muscles of respiration in muscular dystrophy have been shown to slow down overall disease progression and prolong life. The accessory muscles of respiration, whether in human patients or animal models, may prove a viable target especially for therapy directed at specific muscle groups.”

Read more about the study here >

Also check out Respiratory Muscle Training for children with Duchenne Muscular Dystrophy >

The value of breathing retraining

This interesting article, written by osteopath Leon Chaitow, reviews ‘The Value of Breathing Retraining for Better Posture, Balance & Less Pain and Dyskinesis.’

It talks about how problems arising from poor posture, such as back pain for instance, can come about as a result of faulty breathing mechanics.

Chaitow refers to the study, ‘Inspiratory Muscle Training Affects Proprioceptive Use and Low Back Pain’ which supports evidence that breathing training can be successful in rehabilitating function as well as reducing a variety of symptoms.

Participants in the study completed an Inspiratory Muscle Training (IMT) program using the POWERbreathe Medic over a period of 8 weeks, “known as an effective training duration”.

The study concluded: “After 8 wks of high IMT, individuals with LBP (low back pain) showed an increased reliance on back proprioceptive signals during postural control and improved inspiratory muscle strength and severity of LBP, not seen after low IMT. Hence, IMT may facilitate the proprioceptive involvement of the trunk in postural control in individuals with LBP and thus might be a useful rehabilitation tool for these patients.

Read more about the POWERbreathe Medic Classic (used in this study) and the second generation POWERbreathe Medic Plus.

Alleviate screen apnoea by breathing deeply

‘Screen apnoea’ is a new, 21st Century condition. The term is a play on the name for the serious condition, ‘sleep apnoea’. Sufferers with sleep apnoea may stop breathing for short periods of time while they sleep. Surprisingly, a similar thing happens to users of electronic devices. Findings show that people have a tendency to hold their breath while communicating electronically.

About screen apnoea

Screen apnoea is a term now in use by those treating office workers. Findings from a 2009 study leads to this diagnosis. In fact, findings show that while using mobile devices, participants hold their breath and begin to breathe shallowly and rapidly. Additionally, researchers at UCI ICS, (Gloria Mark, Stephen Voida, and Anthony Cardello), formally validate this impact of email, using heart rate variability. Their research shows that our heart rate starts to increase. Furthermore, evidence shows that we tense our muscles while sending and receiving text messages or emails. Although the trial only invited 12 participants, anecdotal evidence is now proving this to be the case.

Have you ever noticed that when you’re really focussed and concentrating hard, you have a tendency to hold your breath? And when concentrating on a small screen, this can result in a tightness in the neck and shoulders. Consequently, this hunching of the body may also cause back pain, thanks to the compromised posture.

Back pain

In a 2006 study of more than 38,000 women, researchers found that back pain was more strongly related to breathing disorders than to obesity or physical activity. This is because the main breathing muscle, the diaphragm, is also one of the core muscles that supports and stabilises the torso. So when the diaphragm’s dual role of breathing and stabilisation is too great, breathing wins out.

Improve your breathing strength

All is not lost though, because the breathing muscles can be exercised to improve their strength and stamina. One of the most effective – and simple – ways of achieving this is through Inspiratory Muscle Training (IMT). IMT uses a resistance that you breathe IN against. It’s this that strengthens your breathing muscles, and in turn, improves your breathing stamina. Furthermore, IMT will help you to breathe deeply into your diaphragm, as opposed to your chest. Finally, IMT is a good teaching practice for your breathing, in an age when we seem to be suffering from screen apnoea.

It’s World COPD Day and POWERbreathe’s here to help!

World COPD Day is an annual event organised by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) to improve awareness and care of COPD around the world. You can stay up-to-date with World COPD Day news as well as connecting with others via their WORLD COPD Facebook page.

COPD (Chronic Obstructive Pulmonary Disease) damages the airways to the lungs and makes it harder for a person with COPD to get air in and out of their lungs, which results in difficulty breathing.

Dyspnoea (difficult, laboured breathing or shortness of breath) is a common feature of COPD and many other disorders, and those diagnosed with COPD will have weak inspiratory muscles (the muscles used to breathe in).

In the study, ‘The Effects of 1 Year of Specific Inspiratory Muscle Training in Patients with COPD‘ published online in CHEST (the official publication of the American College of Chest Physicians) POWERbreathe Inspiratory Muscle Training was shown to elicit:

  • Improvements in inspiratory muscle strength of 55% in patients with Chronic Obstructive Pulmonary Disease (COPD)
  • Improvements in endurance of 86% in patients with Chronic Obstructive Pulmonary Disease (COPD)
  • Improvements in quality of life by 21% in patients with Chronic Obstructive Pulmonary Disease (COPD)
  • Improvements in dyspnoea by 36% in patients with Chronic Obstructive Pulmonary Disease (COPD)

The POWERbreathe Medic is an inspiratory muscle training device (IMT), or respiratory muscle training device (RMT), which is available for prescription in the UK and offers an evidence-based, drug-free treatment for patients with COPD as well as for those with a variety of other medical conditions such as Heart Failure, Asthma, Thoracic Surgery, Ventilator Weaning, Cystic Fibrosis and Neuromuscular Disease.

Prescribed by medical professionals, the hand-held POWERbreathe Medic breathing muscle training device is being prescribed as a standalone intervention or as part of a rehabilitation programme and has no side-effects or drug interactions. Always speak to a medical professional about your medical issues or concerns. Please consult your health care provider before beginning any health related program.

Read more about POWERbreathe for COPD and how the POWERbreathe K-Series has been recognised as the ‘Gold Standard’ RMT (Respiratory Muscle Training) device for important research, and which concluded “that the handheld device provides automatically processed and valid estimates of physical units of energy during loaded breathing tasks. This enables health care providers to quantify the load on inspiratory muscles during these tests in daily clinical practice.”

POWERbreathe and The Arthrogryposis Group

In April we were honoured to be asked by Emma Foden, Sport Scientist and Personal Trainer in disability sport, to talk to the charity, The Arthrogryposis Group at one of their summer events. Each event showcases different health, wellbeing and lifestyle opportunities that are available to them under the banner of Moving and Grooving with Otto; Otto being the charity’s mascot. Naturally we were delighted to be asked and agreed to assist at the event.

The Arthrogryposis Group is a UK based charity for those affected by Arthrogryposis Multiplex Congenita which causes curved joints in parts of the body.

The event we attended was the first in their calendar and took place on the 5th April at Uppingham School, Leicester. It was a ‘Swim Big Meet’ where the focus was to encourage people to swim more as a leisure activity as it helps to mobilise joints, activate muscles and improve cardiovascular strength.

During the event POWERbreathe provided a 30 – 45 minute presentation about the benefits of Inspiratory Muscle Training (IMT) as well as a demonstration of how POWERbreathe works. The importance of stronger breathing muscles for people affected by Arthrogryposis was brought home to us when we heard about a lady who’d been affected so much by this condition that she didn’t have enough air in her lungs to be able to speak.Thankfully POWERbreathe was there to offer her hope…

Because the lungs aren’t a muscle, they rely on the muscles surrounding them for their expansion and contraction. It’s this supporting structure that you need to strengthen and condition in order to appreciate proper, full breathing. So, by using POWERbreathe to exercise her breathing muscles, this lady will be strengthening her lungs’ supporting structure and improving her vital capacity, the usable portion of her lungs.

The day started at 10.30am and we were able to chat to members of the AGM about POWERbreathe before our presentation. We set up the presentation in a sports hall where we were also able to demonstrate the POWERbreathe K5 with Breathe-Link Software. Attendees came and tried out the K5 and took a strength-index test to see how their breathing faired. We were given permission by one member of the group, Neil Andrews, to record his first impressions of the POWERbreathe which you can view here:
“This could change my life” – WATCH VIDEO > 

In the afternoon the pool was open for people who wished to have a leisurely swim or take part in a lesson, as well as shooting, trampolining and fencing to have a go at. It proved to be a very positive, enjoyable day for all involved.

Emma already had personal experience of POWERbreathe and its benefits following the work she did for the study published in the BJSM (British Journal of Sports Medicine), Effects of inspiratory muscle training on respiratory function and repetitive sprint performance in wheelchair basketball players.

Thank you to Emma for contacting us in the first instance and allowing us to help people with potential breathing problems; to The Arthrogryposis Group for being so attentive and interested in POWERbreathe and making it such an enjoyable day; and to Uppingham School for making us all feel welcome in such a lovely environment.

POWERbreathe for Firefighters with Chronic Respiratory Conditions

A study recently published (February 2014) in the International Archives of Occupational and Environmental Health assessed the prevalence of chronic respiratory conditions in (South Australian) metropolitan fire fighters. It also studied associations between occupational exposure, use of respiratory protection and health-related quality of life (HRQoL) in firefighters with and without chronic respiratory conditions.

Study: Chronic respiratory conditions in a cohort of metropolitan fire-fighters: associations with occupational exposure and quality of life.

Methods:

Respiratory symptoms, medical conditions, occupational tasks and exposures and consistency of using respiratory protection were inquired by questionnaire. The Health Survey was used to measure physical and mental health-related quality of life.

Fire-fighters were categorised in subgroups: asthma; COPD/emphysema/chronic bronchitis; no chronic respiratory conditions; and as being ‘not involved’ or ‘involved’ in fire-fighting tasks, the latter further categorised as ‘consistent’ or ‘inconsistent’ use of respiratory protection.

Conclusions:

Ten percent of metropolitan fire-fighters reported underlying chronic respiratory conditions. Presence of such a condition in combination with suboptimal protection from inhaled exposures may lead to poorer physical health-related quality of life.

Read Abstract: Chronic respiratory conditions in a cohort of metropolitan fire-fighters: associations with occupational exposure and quality of life.

How could POWERbreathe help?

A project conducted at the University of Birmingham Sports Medicine and Human Performance Unit into the respiratory performance in firefighters unearthed some not-so-surprising findings:

  • Lung function is impaired whilst wearing SCBA (Self-Contained Breathing Apparatus)
  • Respiratory muscle strength and lung function are impaired further after physical work in SCBA
  • Firefighters adopt a special breathing strategy to minimise the breathlessness induced by working in SCBA

Looking at data from scientific studies, if firefighters performed POWERbreathe Inspiratory Muscle Training for a minimum of 4-weeks, they could:

  • Increase their inspiratory muscle strength
  • Reduce breathlessness
  • Reduce heart rate (1)
  • Reduce the rate of air use from the cylinder (increasing wear time by around 1.5 min from a 15 min cylinder) (1)
  • Increase time to exhaustion (findings from a standard laboratory treadmill test)

(1) Donovan K, McConnell A. Fire-fighters’ Self-contained Breathing Apparatus (SCBA): The Effects of Inspiratory Muscle Training (IMT) during Fire-Fighting Simulations in the Laboratory. In: Hanson, Lovesey, Robertson, editors. Annual Conference of the Ergonomics Society; 1999: Ergonomics Society; 1999. p. 348-52.

Read more about how POWERbreathe could benefit those in the Fire Service.

Using Shaker Plus for my Cystic Fibrosis – my 2 weeks’ progress report

After 14 days of using the Shaker Plus for 30-40 mins twice daily I broke my magic 5 liter volume barrier. My max was 4.8. Magic! I was expecting improvements in maybe a month or two. I’m lost for words.

I knew it was only a matter of time as I could sense the improvements were there. I thought maybe in a month or so, but this is outrageous… To break 5 liters for volume first time ever. I’ve only had it less than 2 weeks — 30-40 mins twice daily. Obsessive?

Regards
Edward.

You can read Edward’s story about why he came to use the Shaker Plus and his experience of using it in his original blog, ‘Using the Shaker Plus as physiotherapy for my Cystic Fibrosis’.

If you have an inspirational story that you’d like to share then please leave a comment here or share it on the POWERbreathe Forum, Facebook or Twitter as we’d love to hear from you.

Using the Shaker Plus as physiotherapy for my Cystic Fibrosis

Edward's results

We received this wonderful story from Edward Wandasiewicz, a cystic fibrosis patient who started using the Shaker Plus by POWERbreathe 10 days ago and is already experiencing some very encouraging results. Here’s his story…

“I purchased about 10 days ago a Shaker Plus for physiotherapy for my cystic fibrosis. I also purchased a POWERbreathe Plus for IMT. I thought I’d use one for mucus clearance (the Shaker Plus) and the other (Powerbreathe) for taking 5-10 breaths after my inhalers to suck the already resting particles even further down. Repeating this action I should get clear airways at level 22-23 of my airways and inhaler particles down there too. That’s the theory anyway…. I’ve been using the Shaker Plus for 30-40 mins twice daily. I actually enjoy doing physio now.

I purchased a medical grade spirometer from Carevision, the Micro 1. My cystic fibrosis clinic at Royal Brompton Hospital use Microloop. Here are my numbers – from a slow blow PEF 50% (Peak Expiratory Flow), and a fast blow 99%. The numbers today for a slow blow FEV1 (Forced Expiratory Volume) and FVC (Forced Vital Capacity) are higher than a fast blow FEV1 and FVC when I was 24-25, my peak best. When I was about 25, the fast blow numbers were FEV1 about 2.2 and FVC about 4.7. Today fast blow is about 2.06 / 4.36. I also had an instantaneous pneumothorax at 29 repaired with talc surgery at 29 and I’m 39 now. No known problems post-surgery since. Here’s a photo of my results for slow blow and fast blow.

I’ve been using the Shaker Plus at level 2 and the results are nothing short of jaw dropping. I sent pictures of my results to my cystic fibrosis team. They can’t believe it either. Think I’ve been inhaling fairy dust or got some kalydeco trial drugs from somewhere. Rest assured I have not.

I actually feel clear and strong like I was when I was 25.

How I came to use Shaker Plus and POWERbreathe

About 15 years ago, in 1995 or so, physio therapist Jennifer Pryor did a trial using the cornet / pep mask / acapella / flutter at the Royal Brompton. She also wrote a few books including Physiotherapy for Respiratory and Cardiac Problems but she has retired now. I ended up choosing the cornet as my favourite device and still do to this day. Unfortunately they don’t make the device or the rubber tubing anymore and it’s become fragile due to hot water cleaning.

I was an inpatient at the Royal Brompton Hospital, and gave autogenic drainage (AD) a go. I found it ok: about 50/50, maybe 60/40 in favour of AD. The cornet is like blowing air underwater in a swimming pool; it really reaches deep down.

On the day of discharge, I picked up a common cold and had to stay in for an extra week. If ever there was a time to continue doing physio, this was it. I had a read of Respiratory Muscle Training: Theory and Practice and hence came across the Powerbreathe website. I gave the Powerbreathe Plus beginner model and Shaker Plus a go.

The Shaker Plus is an awesome device. It’s like the Flutter but a little stronger and much more effective. I compared how much I cleared using the two devices i.e. between my favourite cornet and the Shaker Plus, and the Shaker Plus cleared twice the amount in half the time.

I have developed my own modifications when using the device, such as covering one or two of the holes on the cap to increase resistance or stop air being blown out, being blown back into my eyes.

It’s a great device to use lying on your side too, as you can change the mouthpiece angle. It’s really easy to clean too with no awkward parts like the cornet.

After my purchase of the Shaker Plus 10 days ago, I had a go at spirometry. My results for a slow blow (SEF) measuring FEV1 and FVC equivalents are now greater than a fast blow (FEV) measuring FEV1 and FVC from my early/mid 20s. I have an asthmatic component to my Cystic Fibrosis which makes a fast blow more spurious on results.It’s my favourite physio device now, by a few litres…

I’m possibly going to put the Powerbreathe Plus to one side for the time being. I’ve had one physio say it should be ok to use on a light resistance, given my collapsed lung 10 years ago, but I’m awaiting confirmation from my consultant as it was repaired with talc surgery. I’ve been using a few breaths here and there, but not continuous or too strong. But even from minimal use, I do notice a significant stronger inhalation with my puffers.

I actually feel clear and strong like I was when I was 25. Many thanks for all your hard work and research.”

Regards,
Edward

Message from POWERbreathe: We’d like to thank Edward for getting in touch with us and sharing his amazing story and experience, and we hope that his story inspires others with Cystic Fibrosis to ask their physiotherapist about using this expectoration device that helps mobilise pulmonary secretions without the use of drugs.

We’d also like to offer Edward our best wishes for continued good health and improvement.

If you too have an inspirational story that you’d like to share with others then please leave a comment here or share it on the POWERbreathe Forum, Facebook or Twitter as we’d love to hear from you. Why not also read our blog written by Evan Scully who was diagnosed with cystic fibrosis and has written about his first experience of using POWERbreathe.

POWERbreathe, Exercise Training & Long Term Management of Heart Failure Patients

On 19th September POWERbreathe friend and distributor in Switzerland, Health MG, attended this 3-day training workshop on Rehabilitation and Long Term Management of Heart Failure Patients, at University Hospital, Switzerland.

Regular physical exercise for patients with heart failure is recommended in the guidelines of the European Society of Cardiology as it could ultimately lead to positive changes in myocardial function, symptoms, functional capacity and probably survival. But physical activity is poorly implemented in daily clinical practice.

The aim of the course was to demonstrate the art of exercise training and secondary prevention as well as the interplay between key elements of long term management of heart failure patients.

The workshop was aimed at cardiac rehab physicians, heart failure specialists, cardiologists and GP’s, physiotherapists, sports scientists and nurses and included many aspects of exercise training and testing, including POWERbreathe respiratory muscle training.

The workshop summarised the most current evidence of the benefits of exercise training in patients with heart failure, with practical advice for long-term management, assessment of exercise capacity and the application of different exercise modalities.

POWERbreathe respiratory muscle training has been used as a stand-alone therapy and in cardiac rehabilitation in patients with heart failure and heart disease. Because patients with chronic heart failure (CHF) experience a restrictive pattern of lung function due to pulmonary hypertension, their lung ‘stiffness’ increases the load on their respiratory muscles and makes a significant contribution to their breathlessness. Respiratory muscle training has been shown to successfully increase inspiratory strength and endurance, alleviate breathlessness (dyspnea) and improve functional status in chronic heart failure. POWERbreathe training will only provide a very low cardiovascular strain, making it suitable for the most physically compromised patients and those who’re too ill for rehabilitation.

Read more about POWERbreathe respiratory muscle training for medical conditions, or if you’re already using POWERbreathe to help reduce breathlessness due to breathing problems , then please leave a comment here or on the POWERbreathe Forum, Facebook or Twitter as we’d love to hear from you. You can also read more about POWERbreathe for medical conditions in our POWERbreathe blog.

Effects of IMT in patients with heart failure with preserved ejection fraction

The European Journal of Preventative Cardiology has just published the Abstract of a study that looked to evaluate whether inspiratory muscle training (IMT) would improve exercise capacity, as well as left ventricular diastolic function, biomarker profile and quality of life in patients with advanced heart failure with preserved ejection fraction (HFpEF) and nonreduced maximal inspiratory pressure (MIP).

The results revealed that the IMT group significantly improved their MIP, peak VO2, exercise oxygen uptake at anaerobic threshold, ventilator efficiency, metabolic equivalents and quality of life compared to the control group.

The study concluded therefore, “In HFpEF patients with low aerobic capacity and non-reduced MIP, IMT was associated with marked improvement in exercise capacity and QoL (quality of life).”

Read the full Abstract:

Effects of inspiratory muscle training in patients with heart failure with preserved ejection fraction

Patricia Palau, Eloy Domínguez, Eduardo Núñez et al

Patricia Palau, Cardiology Department, Hospital Clínico Universitario, Blasco Ibáñez 17, 46010 Valencia, Spain

Read more about Inspiratory Muscle Training with POWERbreathe for Chronic Heart Failure as a standalone therapy and for cardiac rehabilitation.