The Need for Breathing Training Techniques: The Elephant in the Heart Failure Cardiac Rehabilitation Room: A Randomized Controlled Trial

HIGHLIGHTS: What is missed? Standard cardiac rehabilitation (CR) programs do not typically consider respiratory symptoms. What are the main findings? Breathing exercises (BE) have a positive physiological effect on chronic heart failure (CHF). What are the implications of the main findings? Future CR programs for CHF have to manage respiratory symptoms. CR programs for CHF have to address patient-centered outcomes. ABSTRACT: Background: Although solid evidence has indicated that respiratory symptoms are common amongst patients with chronic heart failure (CHF), state-of-the-art cardiac rehabilitation (CR) programs do not typically include management strategies to address respiratory symptoms. This study investigated the effect of the addition of breathing exercises (BE) to the CR programs in CHF. Methods: In a two parallel-arm randomized controlled study (RCT), 40 middle-aged patients with CHF and respiratory symptoms were recruited and randomized into two equal groups (n = 20); group (A): standard CR with BE and group (B): standard CR alone. Primary outcomes were respiratory parameters and secondary outcomes included cardiovascular and cardiopulmonary outcomes. All the participants attended a program of aerobic exercise (three sessions/week, 60–75% MHR, 45–55 min) for 12 weeks, plus educational, nutritional, and psychological counseling. Group (A) patients attended the same program together with BE using inspiratory muscle training (IMT) and breathing calisthenics (BC) (six sessions/week, 15–25 min) for the same duration. Results: There was a significant improvement in the respiratory outcomes, and most of the cardiovascular and cardiopulmonary outcomes in both groups with a greater change percentage in group A (p < 0.05). Conclusions: These results indicate that the addition of BE to the CR programs in CHF is effective and is a “patient-centered” approach.