title: Diaphragmatic breathing training program improves abdominal motion during natural breathing in patients with chronic obstructive pulmonary disease: a randomized controlled trial.
abstract: OBJECTIVE
  To investigate the effects of a diaphragmatic breathing training program (DBTP) on thoracoabdominal motion and functional capacity in patients with chronic obstructive pulmonary disease.
  
  
  METHODS
  A prospective, randomized controlled trial.
  
  
  METHODS
  Academic medical center.
  
  
  METHODS
  Subjects (N=30; forced expiratory volume in 1s, 42%±13% predicted) were randomly allocated to either a training group (TG) or a control group (CG).
  
  
  METHODS
  Subjects in the TG completed a 4-week supervised DBTP (3 individualized weekly sessions), while those in the CG received their usual care.
  
  
  METHODS
  Effectiveness was assessed by amplitude of the rib cage to abdominal motion ratio (RC/ABD ratio) (primary outcome) and diaphragmatic mobility (secondary outcome). The RC/ABD ratio was measured using respiratory inductive plethysmography during voluntary diaphragmatic breathing and natural breathing. Diaphragmatic mobility was measured by ultrasonography. A 6-minute walk test and health-related quality of life were also evaluated.
  
  
  RESULTS
  Immediately after the 4-week DBTP, the TG showed a greater abdominal motion during natural breathing quantified by a reduction in the RC/ABD ratio when compared with the CG (F=8.66; P<.001). Abdominal motion during voluntary diaphragmatic breathing after the intervention was also greater in the TG than in the CG (F=4.11; P<.05). The TG showed greater diaphragmatic mobility after the 4-week DBTP than did the CG (F=15.08; P<.001). An improvement in the 6-minute walk test and in health-related quality of life was also observed in the TG.
  
  
  CONCLUSIONS
  DBTP for patients with chronic obstructive pulmonary disease induced increased diaphragm participation during natural breathing, resulting in an improvement in functional capacity.
authors.affiliation: Department of Physical Therapy, School of Medicine, University of São Paulo, São Paulo, Brazil.
authors.forename: Wellington P
authors.initials: WP
authors.lastname: Yamaguti
authors.forename: Renata C
authors.initials: RC
authors.lastname: Claudino
authors.forename: Alberto P
authors.initials: AP
authors.lastname: Neto
authors.forename: Maria C
authors.initials: MC
authors.lastname: Chammas
authors.forename: Andrea C
authors.initials: AC
authors.lastname: Gomes
authors.forename: João M
authors.initials: JM
authors.lastname: Salge
authors.forename: Henrique T
authors.initials: HT
authors.lastname: Moriya
authors.forename: Alberto
authors.initials: A
authors.lastname: Cukier
authors.forename: Celso R
authors.initials: CR
authors.lastname: Carvalho
mesh_terms: D000009:Abdominal Muscles / Q000503:physiopathology; D000368:Aged; D000369:Aged, 80 and over; D001945:Breathing Exercises; D016009:Chi-Square Distribution; D003964:Diaphragm / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000503:physiopathology* / Q000534:rehabilitation*; D011788:Quality of Life; D016896:Treatment Outcome