Skip to main content
SpringerLink
Log in

The Effect of Breathing Retraining Using Metronome-Based Acoustic Feedback on Exercise Endurance in COPD: A Randomized Trial

  • COPD
  • Published:
Lung Aims and scope Submit manuscript

Abstract

Background

During exercise-training patients with chronic obstructive pulmonary disease (COPD) can entrain their breathing pattern to visual-feedback cues as to achieve a slower respiratory rate and prolong exhalation. The result is an improvement in exercise tolerance and a reduction in dynamic hyperinflation. Acoustic stimuli, including metronome-generated acoustic stimuli, can entrain human movements. Accordingly, we hypothesized that exercise duration and dynamic hyperinflation would be less after exercise-training plus breathing-retraining using a metronome-based acoustic-feedback system than after exercise-training alone.

Methods

Of 205 patients with COPD [FEV1 = 44 ± 16% predicted (± SD)] recruited, 119 were randomly assigned to exercise-training plus breathing-retraining using acoustic feedback (n = 58) or exercise-training alone (n = 61). Patients exercised on a treadmill thrice-weekly for 12 weeks. Before and at completion of training, patients underwent constant-load treadmill testing with inspiratory capacity measures every 2 min.

Results

At completion of training, improvements in exercise duration in the breathing-retraining plus exercise-training and exercise-training alone groups were similar (p = 0.35). At isotime, inspiratory capacity increased (less exercise-induced dynamic hyperinflation) by 3% (p = 0.001) in the breathing-retraining plus exercise-training group and remained unchanged in the exercise-alone group. The between-group change in inspiratory capacity, however, was not significant (p = 0.08).

Conclusions

In patients with COPD, breathing-retraining using a metronome-based acoustic feedback did not result in improved exercise endurance or decreased dynamic hyperinflation when compared to exercise-training alone.

Trial registry: ClinicalTrials.gov; No.: NCT NCT01009099; URL: http://www.clinicaltrials.gov

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. O’Donnell DE, Laveneziana P (2006) The clinical importance of dynamic lung hyperinflation in COPD. COPD 3(4):219–232

    Article  PubMed  Google Scholar 

  2. Sinderby C, Spahilja J, Beck J et al (2001) Diaphragm activation during exercise in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 163(7):1637–1641

    Article  CAS  PubMed  Google Scholar 

  3. Sliwinski P, Kaminski D, Zielinski J, Yan S (1998) Partitioning of the elastic work of inspiration in patients with COPD during exercise. Eur Resp J 11(2):416–421

    Article  CAS  Google Scholar 

  4. O’Donnell DE, Revill SM, Webb KA (2001) Dynamic hyperinflation and exercise intolerance in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 164(5):770–777

    Article  PubMed  Google Scholar 

  5. Collins EG, Fehr L, Bammert C et al (2003) Effect of ventilation-feedback training on endurance and perceived breathlessness during constant work-rate leg-cycle exercise in patients with COPD. J Rehabil Res Dev 40(5 Suppl 2):35–44

    Article  PubMed  Google Scholar 

  6. Collins EG, Langbein WE, Fehr L et al (2008) Can ventilation-feedback training augment exercise tolerance in patients with chronic obstructive pulmonary disease? Am J Respir Crit Care Med 177(8):844–852

    Article  PubMed  Google Scholar 

  7. Collins EG, Jelinek C, O’Connell S et al (2014) Contrasting breathing retraining and helium-oxygen during pulmonary rehabilitation in COPD: a randomized clinical trial. Respir Med 108(2):297–306

    Article  PubMed  Google Scholar 

  8. Metcalfe T (2016) The contribution of different musical variables to the effect of background music on motor behavior. Psychomusicol Music Mind Brain 26(2):132–138

    Article  Google Scholar 

  9. Molinari M, Leggio MG, De Martin M, Cerasa A, Thaut M (2003) Neurobiology of rhythmic motor entrainment. Ann N Y Acad Sci 999:313–321

    Article  PubMed  Google Scholar 

  10. Guyatt GH, Berman LB, Townsend M, Pugsley SO, Chambers LW (1987) A measure of quality of life for clinical trials in chronic lung disease. Thorax 42:773–778

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Faling LJ (2003) Controlled breathing techniques and chest physical therapy in chronic obstructive pulmonary disease and allied conditions. In: Casuburi R, Petty TL (eds) Principles and practice of pulmonary rehabilitation. W.B. Saunders, Philadelphia, pp 167–182

    Google Scholar 

  12. Lachin JM (2000) Statistical considerations in the intent-to-treat principle. Controlled Clin Trials 21(3):167–189

    Article  CAS  PubMed  Google Scholar 

  13. Cohen J (1988) Statistical power analysis for the behavioral sciences. Lawrence Erlbaum Associates, Inc., Hillside

    Google Scholar 

  14. O’Donnell DE, McGuire M, Samis L, Webb KA (1998) General exercise training improves ventilatory and peripheral muscle strength and endurance in chronic airflow limitation. Am J Respir Crit Care Med 157(5 Pt 1):1489–1497

    Article  PubMed  Google Scholar 

  15. Casaburi R, Bhasin S, Cosentino L et al (2004) Effects of testosterone and resistance training in men with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 170(8):870–878

    Article  PubMed  Google Scholar 

  16. Ortega F, Toral J, Cejudo P et al (2002) Comparison of effects of strength and endurance training in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 166(5):669–674

    Article  PubMed  Google Scholar 

  17. Porszasz J, Emtner M, Goto S, Somfay A, Whipp BJ, Casaburi R (2005) Exercise training decreases ventilatory requirements and exercise-induced hyperinflation at submaximal intensities in patients with COPD. Chest 128(4):2025–2034

    Article  PubMed  Google Scholar 

  18. Collins EG, Langbein WE, Fehr L, Maloney C (2001) Breathing pattern retraining and exercise in persons with chronic obstructive pulmonary disease. AACN Clin Issues 12(2):202–209

    Article  CAS  PubMed  Google Scholar 

  19. Hausdorff JM, Lowenthal J, Herman T, Gruendlinger L, Peretz C, Giladi N (2007) Rhythmic auditory stimulation modulates gait variability in Parkinson’s disease. Eur J Neurosci 26(8):2369–2375

    Article  PubMed  Google Scholar 

  20. Pomidori L, Contoli M, Mandolesi G, Cogo A (2012) A simple method for home exercise training in patients with chronic obstructive pulmonary disease: one-year study. J Cardiopulm Rehabil Prev 32(1):53–57

    Article  PubMed  Google Scholar 

  21. Lee SS, Kim C, Jin YS et al (2013) Effects of home-based pulmonary rehabilitation with a metronome-guided walking pace in chronic obstructive pulmonary disease. J Korean Med Sci 28(5):738–743

    Article  PubMed  PubMed Central  Google Scholar 

  22. Nittono H, Tsuda A, Akai S, Nakajima Y (2000) Tempo of background sound and performance speed. Percept Mot Skills 90(3 Pt 2):1122

    Article  CAS  PubMed  Google Scholar 

  23. Roberts SE, Stern M, Schreuder FM, Watson T (2009) The use of pursed lips breathing in stable chronic obstructive pulmonary disease: a systematic review of the evidence. Phys Therapy Rev 14(4):240–246

    Article  Google Scholar 

  24. Bianchi R, Gigllotti F, Romagnoli R et al (2007) Patterns of chest wall kinematics during volitional pursed-lip breathing in COPD at rest. Respir Med 101(7):1412–1418

    Article  PubMed  Google Scholar 

  25. Nield MA, Soo Hoo GW, Roper JM, Santiago S (2007) Efficacy of pursed-lips breathing: a breathing pattern retraining strategy for dyspnea reduction. J Cardiopulm Rehabil Prev 27(4):237–244

    Article  PubMed  Google Scholar 

  26. Zhang ZQ, Chen RC, Yang QK, Li P, Wang CZ, Zhang ZH (2008) A randomized controlled trial study of pulmonary rehabilitation with respiratory physiology as the guide on prognosis in patients with chronic obstructive pulmonary disease. Zhongguo Wei Zhong Bing Ji Jiu Yi Xue 20(10):607–610

    PubMed  Google Scholar 

  27. Puhan MA, Guyatt GH, Goldstein R et al (2007) Relative responsiveness of the Chronic Respiratory Questionnaire, St. Georges Respiratory Questionnaire and four other health-related quality of life instruments for patients with chronic lung disease. Respir Med 101(2):308–316

    Article  PubMed  Google Scholar 

  28. Green RH, Singh SJ, Williams J, Morgan MD (2001) A randomised controlled trial of four weeks versus seven weeks of pulmonary rehabilitation in chronic obstructive pulmonary disease. Thorax 56(2):143–145

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Ferreira G, Feuerman M, Spiegler P (2006) Results of an 8-week, outpatient pulmonary rehabilitation program on patients with and without chronic obstructive pulmonary disease. J Cardiopulm Rehabil 26(1):54–60

    Article  PubMed  Google Scholar 

  30. Roca M, Mitu F, Mitu O, Roca IC, Leon MM, Mihaescu T (2015) Characteristics of respiratory mechanics in chronic obstructive pulmonary disease. Rev Med Chir Soc Med Nat Iasi 119(2):361–367

    CAS  PubMed  Google Scholar 

  31. Voscopoulos C, Brayanov J, Ladd D, Lalli M, Panasyuk A, Freeman J (2013) Special article: evaluation of a novel noninvasive respiration monitor providing continuous measurement of minute ventilation in ambulatory subjects in a variety of clinical scenarios. Anesth Analg 117(1):91–100

    Article  PubMed  Google Scholar 

  32. Bernardi E, Pomidori L, Bassal F, Contoli M, Cogo A (2015) Respiratory muscle training with normocapnic hyperpnea improves ventilatory pattern and thoracoabdominal coordination, and reduces oxygen desaturation during endurance exercise testing in COPD patients. Int J Chron Obstruct Pulmon Dis 10:1899–1906

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

The study was supported by grants by the Department of Veterans Affairs, Veterans Health Administration, Office of Research & Development, Rehabilitation Research & Development, Department of Veterans Affairs, Merit Review Grant # F6955R.

Author information

Authors and Affiliations

  1. Department of Biobehavioral Health Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA

    Eileen G. Collins

  2. Physical Performance Laboratory, Research & Development Service, Edward Hines Jr. Veterans Affairs Hospital, Hines, IL, USA

    Eileen G. Collins, Christine Jelinek, Susan O’Connell & Jolene Butler

  3. VA Cooperative Studies Program Coordinating Center, Edward Hines Jr, Veterans Affairs Hospital, Hines, IL, USA

    Domenic Reda

  4. School of Public Health, University of Illinois at Chicago, Chicago, IL, USA

    Domenic Reda

  5. Stritch School of Medicine, Loyola University, Maywood, IL, USA

    Franco Laghi

  6. Pulmonary Medicine, Department of Medicine, Edward Hines Jr, VA Hospital, Hines, IL, USA

    Franco Laghi

Authors
  1. Eileen G. Collins
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Christine Jelinek
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Susan O’Connell
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jolene Butler
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Domenic Reda
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Franco Laghi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Eileen G. Collins.

Ethics declarations

Conflict of interest

The authors have no conflicts of interest to report.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 129 KB)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Collins, E.G., Jelinek, C., O’Connell, S. et al. The Effect of Breathing Retraining Using Metronome-Based Acoustic Feedback on Exercise Endurance in COPD: A Randomized Trial. Lung 197, 181–188 (2019). https://doi.org/10.1007/s00408-019-00198-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00408-019-00198-4

Keywords

Search

Navigation