title: Effect of diaphragmatic breathing on heart rate variability in ischemic heart disease with diabetes.
abstract: BACKGROUND
  Reduced heart rate variability is associated with an unfavorable prognosis in patients with ischemic heart disease and diabetes. Whether change in breathing pattern can modify the risk factor in these patients has not been definitely proved.
  
  
  OBJECTIVE
  To evaluate the effect of diaphragmatic breathing on heart rate variability (HRV) in ischemic heart disease patients with diabetes.
  
  
  METHODS
  Study population consisted of 145 randomly selected male patients of which 45 had ischemic heart disease (IHD), 52 had IHD and diabetes (IHD-DM) and the remaining 48 had IHD and diabetic neuropathy (IHD-DN). HRV was assessed by 5 minute-electrocardiogram using the time domain method. The intervention group was divided into compliant and non-compliant groups and follow-up recording was carried out after three months and one year.
  
  
  RESULTS
  Baseline recordings showed a significant decrease in HRV in ischemic heart disease (IHD) patients with or without diabetes (p<0.01). IHD patients had higher HRV than IHD patients with diabetes (p<0.01) or diabetic neuropathy (p<0.01). Increase in HRV was observed in patients who practiced diaphragmatic breathing for three months (IHD-DM: p<0.01; IHD-DN: p<0.05) and for one year (IHD-DM: p<0.01; IHD-DN: p<0.01). The HRV significantly decreased after one year in non-compliant patients. The regular practice of diaphragmatic breathing also improved the glycemic index in these patients.
  
  
  CONCLUSIONS
  The regular practice of diaphragmatic breathing significantly improves heart rate variability with a favorable prognostic picture in ischemic heart disease patients who have diabetes. These effects seem to be potentially beneficial in the management of IHD patients with diabetes.
authors.affiliation: Faculty of Medicine, University College of Sedaya International, Kuala Lumpur, Malaysia.
authors.forename: Anupama Bangra
authors.initials: AB
authors.lastname: Kulur
authors.forename: Nagaraja
authors.initials: N
authors.lastname: Haleagrahara
authors.forename: Prabha
authors.initials: P
authors.lastname: Adhikary
authors.forename: P S
authors.initials: PS
authors.lastname: Jeganathan
mesh_terms: D001945:Breathing Exercises; D048909:Diabetes Complications / Q000145:classification; D003964:Diaphragm; D004812:Epidemiologic Methods; D005500:Follow-Up Studies; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000503:physiopathology / Q000628:therapy*; D010349:Patient Compliance / Q000706:statistics & numerical data