Skip to main content
SpringerLink
Log in

Combined Heart Rate Variability and Pulse Oximetry Biofeedback for Chronic Obstructive Pulmonary Disease: Preliminary Findings

  • Published:
Applied Psychophysiology and Biofeedback Aims and scope Submit manuscript

Abstract

The purpose of this study was to examine the feasibility of an intervention that included heart rate variability (HRV) biofeedback and walking with pulse oximetry feedback to improve functioning and quality of life for patients with chronic obstructive pulmonary disease (COPD). Twenty patients with COPD participated in 5 weekly sessions of HRV biofeedback and 4 weekly sessions of walking practice with oximetry feedback, with instructions for daily home practice. Primary outcomes measures were the distance walked in 6 min (6MWD) and overall quality of life, as measured by the St. George's Respiratory Questionnaire (SGRQ). Secondary outcomes included measures of self-efficacy, self-reported disability, anxiety, depression, dyspnea before and after the 6MWD, and HRV at the frequency of respiration during spontaneous and paced breathing. After 10 weeks of training, participants showed statistically and clinically significant improvements in 6MWD and quality of life. Significant changes were also seen in self-efficacy, disability, dyspnea before and after the 6MWD, and HRV amplitude during spontaneous breathing. We conclude that our intervention is feasible for patients with COPD and that further research using a randomized controlled design is warranted.

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

Similar content being viewed by others

REFERENCES

  • American Thoracic Society. (1995a). Standards for the diagnosis and care of patients with chronic obstructive pulmonary disease. American Journal of Respiratory and Critical Care Medicine, 152, S77-S121.

    Google Scholar 

  • American Thoracic Society. (1995b). Standardization of spirometry, 1994 update. American Journal of Respiratory and Critical Care Medicine, 152, 1107-1136.

    Google Scholar 

  • American Thoracic Society. (2002). ATS statement: Guidelines for the six-minute walk test. American Journal of Respiratory and Critical Care Medicine, 166, 111-117.

    Google Scholar 

  • Arias, E., & Smith, B. L. (2003). Deaths: Preliminary data for 2001. In National vital statistics report (Vol. 51, Issue 5). Hyattsville, MD: National Center for Health Statistics.

    Google Scholar 

  • Barach, A. L. (1973). Physiologic advantages of grunting, groaning, and pursed-lip breathing: Adaptive symptoms related to the development of continuous positive pressure breathing. Bulletin of the New York Academy of Medicine, 49, 666-673.

    Google Scholar 

  • Bernardi, L., Gabutti, A., Porta, C., & Spicuzza, L. (2001). Slow breathing reduces chemoreflex response to hypoxia and hypercapnia, and increases baroreflex sensitivity. Journal of Hypertension, 19, 2221-2229.

    Google Scholar 

  • Berntson, G. G., Bigger, J. T., Eckberg, D. L., Grossman, P., Kaufmann, P. G., Malik, M., et al. (1997). Heart rate variability: Origins, methods, and interpretive caveats. Psychophysiology, 34, 623-648.

    Google Scholar 

  • Breslin, E. H. (1995). Breathing retraining in chronic obstructive pulmonary disease. Journal of Cardiopulmonary Rehabilitation, 15, 25-33.

    Google Scholar 

  • Brown, T. E., Beightol, L. A., Koh, J., & Eckberg, D. L. (1993). Important influence of respiration on human R-R interval power spectra is largely ignored. Journal of Applied Physiology, 75, 2310-2317.

    Google Scholar 

  • Casciari, R. J., Fairshter, R. D., Harrison, A., Morrison, J. T., Blackburn, C., & Wilson, A. F. (1981). Effects of breathing retraining in patients with chronic obstructive pulmonary disease. Chest, 79, 393-398.

    Google Scholar 

  • Challapalli, S., Kadish, A. H., Horvath, G., & Goldberger, J. J. (1999). Differential effects of parasympathetic blockade and parasympathetic withdrawal on heart rate variability. Journal of Cardiovascular Electrophysiology, 10, 1192-1199.

    Google Scholar 

  • Delk, K. K., Gevirtz, R., Hicks, D. A., Carden, F., & Rucker, R. (1994). The effects of biofeedback assisted breathing retraining on lung functions in patients with cystic fibrosis. Chest, 105, 23-28.

    Google Scholar 

  • Dowson, C., Laing, R., Barraclough, R., Town, I., Mulder, R., Norris, K., et al. (2001). The use of the Hospital Anxiety and Depression Scale (HADS) in patients with chronic obstructive pulmonary disease: A pilot study.New Zealand Medical Journal, 114, 447-449.

    Google Scholar 

  • Esteve, F., Blanc-Gras, N., Gallego, J., & Benchetrit, G. (1996). The effects of breathing pattern training on ventilatory function in patients with COPD. Biofeedback and Self Regulation, 21, 311-321.

    Google Scholar 

  • Faling, L. J. (1986). Pulmonary rehabilitation-physical modalities. Clinics in ChestMedicine, 7, 599-618.

    Google Scholar 

  • Giardino, N. D., Chan, L., & Borson, S. (2003). Respiratory sinus arrhythmia is associated with pulmonary gas exchange efficiency in chronic obstructive pulmonary disease. Manuscript submitted for publication.

  • Giardino, N. D., Glenny, R. W., Borson, S., & Chan, L. (2003). Respiratory sinus arrhythmia is associated with efficiency of pulmonary gas exchange in healthy humans. American Journal of Physiology: Heart and Circulatory Physiology, 284, H1585-H1591.

    Google Scholar 

  • Goldberger, J. J., Ahmed, M. W., Parker, M. A., & Kadish, A. H. (1994). Dissociation of heart rate variability from parasympathetic tone. American Journal of Physiology, 266, H2152-H2157.

    Google Scholar 

  • Goldberger, J. J., Challapalli, S., Tung, R., Parker, M. A., & Kadish, A. H. (2001). Relationship of heart rate variability to parasympathetic effect. Circulation, 103, 1977-1983.

    Google Scholar 

  • Grossman, P., Karemaker, J., & Wieling, W. (1991). Prediction of tonic parasympathetic cardiac control using respiratory sinus arrhythmia: The need for respiratory control. Psychophysiology, 28, 201-216.

    Google Scholar 

  • Hayano, J., & Yasuma, F. (2003). Hypothesis: Respiratory sinus arrhythmia is an intrinsic resting function of cardiopulmonary system. Cardiovascular Research, 58, 1-9.

    Google Scholar 

  • Hayano, J., Yasuma, F., Okada, A., Mukai, S., & Fujinami, T. (1996). Respiratory sinus arrhythmia.Aphenomenon improving pulmonary gas exchange and circulatory efficiency. Circulation, 94, 842-847.

    Google Scholar 

  • Hirsch, J. A., & Bishop, B. (1981). Respiratory sinus arrhythmia in humans: How breathing pattern modulates heart rate. American Journal of Physiology, 241, 620-629.

    Google Scholar 

  • Iellamo, F., Legramante, J. M., Pigozzi, F., Spataro, A., Norbiato, G., Lucini, D., et al. (2002). Conversion from vagal to sympathetic predominance with strenuous training in high-performance world class athletes. Circulation, 105, 2719-2724.

    Google Scholar 

  • Jones, P. W. (1998). Testing health status (“quality of life”) questionnaires for asthma andCOPD. European Respiratory Journal, 11, 5-6.

    Google Scholar 

  • Jones, P. W., Quirk, F. H., Baveystock, C. M., & Littlejohns, P. (1992). A self-complete measure of health status for chronic airflow limitation. The St. George's Respiratory Questionnaire. American Review Respiratory Disease, 145, 1321-1327.

    Google Scholar 

  • Lareau, S. C., Meek, P. M., & Roos, P. J. (1998). Development and testing of the modified version of the pulmonary functional status and dyspnea questionnaire (PFSDQ-M). Heart and Lung, 27, 159-168.

    Google Scholar 

  • Lehrer, P., Carr, R. E., Smetankine, A., Vaschillo, E., Peper, E., Porges, S., et al. (1997). Respiratory sinus arrhythmia versus neck/trapezius EMG and incentive inspirometry biofeedback for asthma: A pilot study.Applied Psychophysiology and Biofeedback, 22, 95-109.

    Google Scholar 

  • Lehrer, P., Smetankin, A., & Potapova, T. (2000). Respiratory sinus arrhythmia biofeedback therapy for asthma: A report of 20 unmedicated pediatric cases using the Smetankin method. Applied Psychophysiology and Biofeedback, 25, 193-200.

    Google Scholar 

  • Lehrer, P. M., Vaschillo, E., & Vaschillo, B. (2000). Resonant frequency biofeedback training to increase cardiac variability: Rationale and manual for training. Applied Psychophysiology and Biofeedback, 25, 177-191.

    Google Scholar 

  • Mezzacappa, E. S., Kelsey, R. M., Katkin, E. S., & Sloan, R. P. (2001). Vagal rebound and recovery from psychological stress. Psychosomatic Medicine, 63, 650-657.

    Google Scholar 

  • Miller, W. F. (1954). A physiologic evaluation of the effects of diaphragmatic breathing training in patients with chronic pulmonary emphysema. American Journal of Medicine, 17, 471-477.

    Google Scholar 

  • Motley, H. L. (1963). The effects of slow deep breathing on the blood gas exchange in emphysema. American Review Respiratory Disease, 88, 485-492.

    Google Scholar 

  • Mueller, R. E., Petty, T. L., & Filley, G. F. (1970). Ventilation and arterial blood gas changes induced by pursed-lips breathing. Journal of Applied Physiology, 28, 784-789.

    Google Scholar 

  • Murray, C. J. L., & Lopez, A. D. (1996). The global burden of disease: A comprehensive assessment of mortality and disability from diseases, injuries, and risk factors in 1990 and projected to 2020. Cambridge, MA: Harvard School of Public Health on behalf of the World Health Organization and the World Bank.

    Google Scholar 

  • Nelesen, R. A., Yu, H., Ziegler, M. G., Mills, P. J., Clausen, J. L., & Dimsdale, J. E. (2001). Continuous positive airway pressure normalizes cardiac autonomic and hemodynamic responses to a laboratory stressor in apneic patients. Chest, 119, 1092-1101.

    Google Scholar 

  • Pagani, M., Lucini, D., Pizzinelli, P., Sergi, M., Bosisio, E., Mela, G. S., et al. (1996). Effects of aging and of chronic obstructive pulmonary disease on RR interval variability. Journal of the Autonomic Nervous System, 59, 125-132.

    Google Scholar 

  • Paul, G., Eldridge, F., Mitchell, J., & Fiene, T. (1966). Some effects of slowing respiration rate in chronic emphysema and bronchitis. Journal of Applied Physiology, 21, 877-882.

    Google Scholar 

  • Salman, G. F., Mosier, M. C., Beasley, B. W., & Calkins, D. R. (2003). Rehabilitation for patients with chronic obstructive pulmonary disease: Meta-analysis of randomized controlled trials. Journal of General Internal Medicine, 18, 213-221.

    Google Scholar 

  • Sargunaraj, D., Lehrer, P. M., Hochron, S. M., Rausch, L., Edelberg, R., & Porges, S. W. (1996). Cardiac rhythm effects of.125-Hz paced breathing through a resistive load: Implications for paced breathing therapy and the polyvagal theory. Biofeedback and Self Regulation, 21, 131-147.

    Google Scholar 

  • Saul, J. P., Berger, R. D., Chen, M. H., & Cohen, R. J. (1989). Transfer function analysis of autonomic regulation. II. Respiratory sinus arrhythmia. American Journal of Physiology, 256, 153-161.

    Google Scholar 

  • Silverman, E. K., & Speizer, F. E. (1996). Risk factors for the development of chronic obstructive pulmonary disease. Medical Clinics of North America, 80, 501-522.

    Google Scholar 

  • Stein, P. K., Nelson, P., Rottman, J. N., Howard, D., Ward, S. M., Kleiger, R. E., et al. (1998). Heart rate variability reflects severity of COPD in PiZ alpha1-antitrypsin deficiency. Chest, 113, 327-333.

    Google Scholar 

  • Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. (1996). Heart rate variability. Standards of measurement, physiological interpretation, and clinical use. European Heart Journal, 17, 354-381.

    Google Scholar 

  • Tiep, B. L., Burns, M., Kao, D., Madison, R., & Herrera, J. (1986). Pursed-lips breathing training using ear oximetry. Chest, 90, 218-221.

    Google Scholar 

  • Vaschillo, E. G. (1984). Dynamics of slow-wave cardiac rhythm structure as an index of the functional state of an operant. Unpublished doctoral dissertation, Leningrad State University, Russia.

    Google Scholar 

  • Vaschillo, E., Lehrer, P., Rishe, N., & Konstantinov, M. (2002). Heart rate variability biofeedback as a method for assessing baroreflex function: A preliminary study of resonance in the cardiovascular system. Applied Psychophysiology and Biofeedback, 27, 1-27.

    Google Scholar 

  • Volterrani, M., Scalvini, S., Mazzuero, G., Lanfranchi, P., Colombo, R., Clark, A. L., et al. (1994). Decreased heart rate variability in patients with chronic obstructive pulmonary disease. Chest, 106, 1432-1437.

    Google Scholar 

  • Wigal, J. K., Creer, T. L., & Kotses, H. (1991). The COPD Self-Efficacy Scale. Chest, 99, 1193-1196.

    Google Scholar 

  • Yasuma, F., & Hayano, J. (2001). Augmentation of respiratory sinus arrhythmia in response to progressive hypercapnia in conscious dogs. American Journal of Physiology: Heart and Circulatory Physiology, 280, H2336-H2341.

    Google Scholar 

  • Zigmond, A. S., & Snaith, R. P. (1983). The hospital anxiety and depression scale. Acta Psychiatrica Scandinavica, 67, 361-370.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Rehabilitation Medicine, University of Washington, Seattle, Washington

    Nicholas D. Giardino & Leighton Chan

  2. Department of Psychology, University of Cincinnati, P.O. Box 210376, Cincinnati, Ohio, USA, 45221

    Nicholas D. Giardino

  3. Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington

    Soo Borson

Authors
  1. Nicholas D. Giardino
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Leighton Chan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Soo Borson
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Giardino, N.D., Chan, L. & Borson, S. Combined Heart Rate Variability and Pulse Oximetry Biofeedback for Chronic Obstructive Pulmonary Disease: Preliminary Findings. Appl Psychophysiol Biofeedback 29, 121–133 (2004). https://doi.org/10.1023/B:APBI.0000026638.64386.89

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1023/B:APBI.0000026638.64386.89

Search

Navigation