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

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.

[1]  S. Scalvini,et al.  Decreased heart rate variability in patients with chronic obstructive pulmonary disease. , 1994, Chest.

[2]  P. Stein,et al.  Heart Rate Variability Reflects Severity of COPD in PiZ α1-Antitrypsin Deficiency , 1998 .

[3]  R. Edelberg,et al.  Respiratory Sinus Arrhythmia Versus Neck/Trapezius EMG and Incentive Inspirometry Biofeedback for Asthma: A Pilot Study , 1997, Applied psychophysiology and biofeedback.

[4]  E. Arias,et al.  Deaths: preliminary data for 2011. , 2012, National vital statistics reports : from the Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System.

[5]  P. Lehrer,et al.  Resonant Frequency Biofeedback Training to Increase Cardiac Variability: Rationale and Manual for Training , 2000, Applied psychophysiology and biofeedback.

[6]  E. Silverman,et al.  Risk factors for the development of chronic obstructive pulmonary disease. , 1996, The Medical clinics of North America.

[7]  J. Saul,et al.  Transfer function analysis of autonomic regulation. II. Respiratory sinus arrhythmia. , 1989, The American journal of physiology.

[8]  H. Kotses,et al.  The COPD Self-Efficacy Scale. , 1991, Chest.

[9]  A. Kadish,et al.  Dissociation of heart rate variability from parasympathetic tone. , 1994, The American journal of physiology.

[10]  Naphtali Rishe,et al.  Heart Rate Variability Biofeedback as a Method for Assessing Baroreflex Function: A Preliminary Study of Resonance in the Cardiovascular System , 2002, Applied psychophysiology and biofeedback.

[11]  J. Dimsdale,et al.  Continuous positive airway pressure normalizes cardiac autonomic and hemodynamic responses to a laboratory stressor in apneic patients. , 2001, Chest.

[12]  Soo Borson,et al.  Respiratory sinus arrhythmia is associated with efficiency of pulmonary gas exchange in healthy humans. , 2003, American journal of physiology. Heart and circulatory physiology.

[13]  P. Lehrer,et al.  Respiratory Sinus Arrhythmia Biofeedback Therapy for Asthma: A Report of 20 Unmedicated Pediatric Cases Using the Smetankin Method , 2000, Applied psychophysiology and biofeedback.

[14]  B. Make,et al.  Standards for the diagnosis and care of patients with chronic obstructive pulmonary disease. American Thoracic Society. , 1995, American journal of respiratory and critical care medicine.

[15]  R. Casciari,et al.  Effects of breathing retraining in patients with chronic obstructive pulmonary disease. , 1981, Chest.

[16]  Michele A. Parker,et al.  Relationship of Heart Rate Variability to Parasympathetic Effect , 2001, Circulation.

[17]  B. Tiep,et al.  Pursed lips breathing training using ear oximetry. , 1986, Chest.

[18]  E. Katkin,et al.  Vagal Rebound and Recovery From Psychological Stress , 2001, Psychosomatic medicine.

[19]  Massimo Pagani,et al.  Conversion From Vagal to Sympathetic Predominance With Strenuous Training in High-Performance World Class Athletes , 2002, Circulation.

[20]  G. Filley,et al.  Ventilation and arterial blood gas changes induced by pursed lips breathing. , 1970, Journal of applied physiology.

[21]  Alan D. Lopez,et al.  The global burden of disease: a comprehensive assessment of mortality and disability from diseases injuries and risk factors in 1990 and projected to 2020. , 1996 .

[22]  P. Jones,et al.  A self-complete measure of health status for chronic airflow limitation. The St. George's Respiratory Questionnaire. , 1992, The American review of respiratory disease.

[23]  H. L. Motley.  THE EFFECTS OF SLOW DEEP BREATHING ON THE BLOOD GAS EXCHANGE IN EMPHYSEMA. , 2015, The American review of respiratory disease.

[24]  J. Gallego,et al.  The effects of breathing pattern training on ventilatory function in patients with COPD , 1996, Biofeedback and self-regulation.

[25]  P. Grossman,et al.  Prediction of tonic parasympathetic cardiac control using respiratory sinus arrhythmia: the need for respiratory control. , 1991, Psychophysiology.

[26]  K. Norris,et al.  The use of the Hospital Anxiety and Depression Scale (HADS) in patients with chronic obstructive pulmonary disease: a pilot study. , 2001, The New Zealand medical journal.

[27]  R. Gevirtz,et al.  The effects of biofeedback assisted breathing retraining on lung functions in patients with cystic fibrosis. , 1994, Chest.

[28]  R. Edelberg,et al.  Cardiac rhythm effects of .125-Hz paced breathing through a resistive load: Implications for paced breathing therapy and the polyvagal theory , 1996, Biofeedback and self-regulation.

[29]  A. Malliani,et al.  Heart rate variability. Standards of measurement, physiological interpretation, and clinical use , 1996 .

[30]  Jones Pw.  Testing health status (“quality of life”) questionnaires for asthma and COPD , 1998 .

[31]  D. Eckberg,et al.  Important influence of respiration on human R-R interval power spectra is largely ignored. , 1993, Journal of applied physiology.

[32]  A Malliani,et al.  Effects of aging and of chronic obstructive pulmonary disease on RR interval variability. , 1996, Journal of the autonomic nervous system.

[33]  S. Lareau,et al.  Development and testing of the modified version of the pulmonary functional status and dyspnea questionnaire (PFSDQ-M). , 1998, Heart & lung : the journal of critical care.

[34]  W. F. Miller.  A physiologic evaluation of the effects of diaphragmatic breathing training in patients with chronic pulmonary emphysema. , 1954, The American journal of medicine.

[35]  F. Yasuma,et al.  Hypothesis: respiratory sinus arrhythmia is an intrinsic resting function of cardiopulmonary system. , 2003, Cardiovascular research.

[36]  Augmentation of respiratory sinus arrhythmia in response to progressive hypercapnia in conscious dogs. , 2001, American journal of physiology. Heart and circulatory physiology.

[37]  A. L. Barach.  Physiologic advantages of grunting, groaning, and pursed-lip breathing: adaptive symptoms related to the development of continuous positive pressure breathing. , 1973, Bulletin of the New York Academy of Medicine.

[38]  L. Bernardi,et al.  Slow breathing reduces chemoreflex response to hypoxia and hypercapnia, and increases baroreflex sensitivity , 2001, Journal of hypertension.

[39]  A. Kadish,et al.  Differential Effects of Parasympathetic Blockade and Parasympathetic Withdrawal on Heart Rate Variability , 1999, Journal of cardiovascular electrophysiology.

[40]  H. Nagaraja,et al.  Heart rate variability: origins, methods, and interpretive caveats. , 1997, Psychophysiology.

[41]  J. Hirsch,et al.  Respiratory sinus arrhythmia in humans: how breathing pattern modulates heart rate. , 1981, The American journal of physiology.

[42]  John L. Hankinson,et al.  Standardization of Spirometry, 1994 Update. American Thoracic Society. , 1995, American journal of respiratory and critical care medicine.

[43]  F. Yasuma,et al.  Respiratory sinus arrhythmia. A phenomenon improving pulmonary gas exchange and circulatory efficiency. , 1996, Circulation.

[44]  R. Snaith,et al.  The Hospital Anxiety and Depression Scale , 1983 .