Effects of home-based breathing exercise on heart rate variability, cardio-ankle vascular index, respiratory muscle strength and maximum oxygen consumption in female participants with normal weight obesity
Article Sidebar
Main Article Content
Abstract
Background: Obesity causes autonomic imbalance and decreases exercise capacity, which limit exercise and physical activity. Normal-weight obesity (NWO) is defined as normal body mass index (BMI), but increased body fat percentage (BF%) associated with cardiorespiratory impairment in early adulthood. The benefit of slow breathing has shown to enhance cardiorespiratory functions in overweight and generally obese people. Moreover, the slow breathing affects to the heart rate variability (HRV), cardio ankle vascular index (CAVI), respiratory muscle strength and indirect maximum oxygen consumption (indirect VO2max) has not been studied in female individuals with NWO.
Objectives: To determine the effects of slow breathing exercise on HRV, CAVI, respiratory muscle strength and VO2max in female participants aged 20-30 years, who have normal BMI (18.5-22.9 kg/m2, n=19 each group) and high body fat (BF) (BF ≥30%), compared with a control group, which carried out routine physical activity.
Materials and methods: Participants with NWO were divided randomly into two groups: control and intervention group, which performed breathing exercise at home. All of the participants were measured for body composition, blood pressure, HRV and CAVI. An electronic pressure transducer and cycle ergometer were applied to assess respiratory muscle strength and indirect VO2max. All measurements were recorded before and after 4 weeks when completely intervention. The demographic data between the groups was analyzed the significant difference by using the independent t test. The data at baseline and four weeks after intervention was determine by two way ANOVA. P-value less than 0.05 was considered statistically significant.
Results: Participants with NWO, who received breathing exercise at home, showed lower autonomic imbalance, and systolic blood pressure, whereas improved maximum inspiratory pressure (MIP), but no statistical change in maximum expiratory pressure (MEP), indirect VO2max, CAVI or ankle brachial index (ABI) (p>0.05).
Conclusion: Slow breathing exercise can improve autonomic balance and inspiratory muscle strength in physically inactive female NWO participants.
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Personal views expressed by the contributors in their articles are not necessarily those of the Journal of Associated Medical Sciences, Faculty of Associated Medical Sciences, Chiang Mai University.
References
Kim SY. The definition of obesity. Korean J Fam Med 2016; 37(6): 309.
Oliveros E, Somers VK, Sochor O, Goel K, Lopez-Jimenez F. The concept of normal weight obesity. Prog Cardiovasc Dis 2014; 56(4): 426-33.
Kapoor N, Furler J, Paul TV, Thomas N, Oldenburg B. Normal weight obesity: an underrecognized problem in individuals of south asian descent. Clin Ther 2019; 41(8): 1638-42.
Verrier RL, Tan A. Heart rate, autonomic markers, and cardiac mortality. Heart Rhythm 2009; 6 (Suppl 11): S68-75.
Sun CK. Cardio-ankle vascular index (CAVI) as an indicator of arterial stiffness. Integr Blood Press Control 2013; 6: 27-38.
Di Bello V, Fabiani I, Calogero E, Colonna P, Carerj S, Canterin FA, et al. Clinical usefulness of cardio-ankle vascular index, local artery carotid stiffness and global longitudinal strain in subjects with cardiovascular risk factors. J Cardiovasc Echogr 2017; 27(3): 81-7.
Yadav RL, Yadav PK, Yadav LK, Agrawal K, Sah SK, Islam MN. Association between obesity and heart rate variability indices: an intuition toward cardiac autonomic alteration - a risk of CVD. Diabetes Metab Syndr Obes 2017; 10: 57-64.
Rabbia F, Silke B, Conterno A, Grosso T, De Vito B, Rabbone I, et al. Assessment of cardiac autonomic modulation during adolescent obesity. Obes Res 2003; 11(4): 541-8.
Satoh N, Shimatsu A, Kato Y, Araki R, Koyama K, Okajima T, et al. Evaluation of the cardio-ankle vascular index, a new indicator of arterial stiffness independent of blood pressure, in obesity and metabolic syndrome. Hypertens Res 2008; 31(10): 1921-30.
Franco LP, Morais CC, Cominetti C. Normal-weight obesity syndrome: diagnosis, prevalence, and clinical implications. Nutr Rev 2016; 74(9): 558-70.
Habibi E, Dehghan H, Moghiseh M, Hasanzadeh A. Study of the relationship between the aerobic capacity (VO2 max) and the rating of perceived exertion based on the measurement of heart beat in the metal industries Esfahan. J Educ Health Promot 2014; 3: 55.
Sutherland TJ, McLachlan CR, Sears MR, Poulton R, Hancox RJ. The relationship between body fat and respiratory function in young adults. Eur Respir J 2016; 48(3): 734-47.
Frank I, Briggs R, Spengler CM. Respiratory muscles, exercise performance, and health in overweight and obese subjects. Med Sci Sports Exerc 2011; 43(4): 714-27.
Scano G, Stendardi L, Bruni GI. The respiratory muscles in eucapnic obesity: their role in dyspnea. Respir Med 2009; 103(9): 1276-85.
Russo MA, Santarelli DM, O'Rourke D. The physiological effects of slow breathing in the healthy human. Breathe (Sheff) 2017; 13(4): 298-309.
Rachatakarn R, Rittimanomai P, Pongthorn I, Kornanong Y. Preliminary outcome of the effect of slow and deep breathing exercise program on respiratory muscle strength in healthy participants aged 18 – 25: a randomized control trial. Journal of health science 2017; 25(3): 387-93 (in Thai).
Kirby J, Levin KA, Inchley J. Socio-environmental influences on physical activity among young people: a qualitative study. Health Educ Res 2013; 28(6): 954-69.
Nagarajan S. Effect of slow breathing training for a month on blood pressure and heart rate variability in healthy subjects. Natl J Physiol Pharm Pharmacol 2014; 4(3): 245-8.
Anderson DE, McNeely JD, Windham BG. Regular slow-breathing exercise effects on blood pressure and breathing patterns at rest. J Hum Hypertens 2010; 24(12): 807-13.
Stegenga H, Haines A, Jones K, Wilding J, Guideline Development G. Identification, assessment, and management of overweight and obesity: summary of updated NICE guidance. BMJ 2014; 349: g6608.
Kim JY, Han SH, Yang BM. Implication of high-body-fat percentage on cardiometabolic risk in middle-aged, healthy, normal-weight adults. Obesity (Silver Spring) 2013; 21(8): 1571-7.
Knight JA. Physical inactivity: associated diseases and disorders. Ann Clin Lab Sci 2012; 42(3): 320-37.
Bennett JA, Winters-Stone K, Nail LM, Scherer J. Definitions of sedentary in physical activity intervention trials: a summary of the literature. J Aging Phys Act 2006; 14(4): 456-77.
Myers J, Forman DE, Balady GJ, Franklin BA, Nelson-Worel J, Martin BJ, et al. Supervision of exercise testing by nonphysicians: a scientific statement from the american heart association. Circulation 2014; 130(12): 1014-27.
Heyward VH, Wagner DR. Applied body composition assessment. Champaign (IL): Human kinetics; 2004.
Pereira C, Silva RAD, de Oliveira MR, Souza RDN, Borges RJ, Vieira ER. Effect of body mass index and fat mass on balance force platform measurements during a one-legged stance in older adults. Aging Clin Exp Res 2018; 30(5): 441-7.
Oshima Y, Shiga T, Namba H, Kuno S. Estimation of whole-body skeletal muscle mass by bioelectrical impedance analysis in the standing position. Obes Res Clin Pract 2010; 4(1): e1-e82.
Verma S, Bhati P, Ahmad I, Masroor S, Ali K, Singla D, et al. Co-Existence of hypertension worsens post-exercise cardiac autonomic recovery in type 2 diabetes. Indian Heart J 2018; 70 (Suppl 3): S82-S9.
Shaffer F, Ginsberg JP. An Overview of Heart Rate Variability Metrics and Norms. Front Public Health 2017; 5: 258.
Heart rate variability: standards of measurement, physiological interpretation and clinical use. task force of the european society of cardiology and the north american society of pacing and electrophysiology. Circulation 1996; 93(5): 1043-65.
Miyoshi T, Ito H, Horinaka S, Shirai K, Higaki J, Orimo H. Protocol for evaluating the cardio-ankle vascular index to predict cardiovascular events in japan: a prospective multicenter cohort study. Pulse (Basel) 2017; 4(Suppl 1): 11-6.
American Thoracic Society/European Respiratory S. ATS/ERS Statement on respiratory muscle testing. Am J Respir Crit Care Med 2002; 166(4): 518-624.
Black LF, Hyatt RE. Maximal respiratory pressures: normal values and relationship to age and sex. Am Rev Respir Dis 1969; 99(5): 696-702.
Neder JA, Andreoni S, Lerario MC, Nery LE. Reference values for lung function tests. II. Maximal respiratory pressures and voluntary ventilation. Braz J Med Biol Res 1999; 32(6): 719-27.
Cink RE, Thomas TR. Validity of the astrand-ryhming nomogram for predicting maximal oxygen intake. Br J Sports Med 1981; 15(3): 182-5.
Thompson PD, Arena R, Riebe D, Pescatello LS, American College of Sports M. ACSM's new preparticipation health screening recommendations from ACSM's guidelines for exercise testing and prescription, ninth edition. Curr Sports Med Rep 2013; 12(4): 215-7.
Mafort TT, Rufino R, Costa CH, Lopes AJ. Obesity: systemic and pulmonary complications, biochemical abnormalities, and impairment of lung function. Multidiscip Respir Med 2016; 11: 28.
St Croix CM, Morgan BJ, Wetter TJ, Dempsey JA. Fatiguing inspiratory muscle work causes reflex sympathetic activation in humans. J Physiol 2000; 529 493-504.
Rossi RC, Vanderlei LC, Goncalves AC, Vanderlei FM, Bernardo AF, Yamada KM, et al. Impact of obesity on autonomic modulation, heart rate and blood pressure in obese young people. Auton Neurosci 2015; 193: 138-41.
Joseph CN, Porta C, Casucci G, Casiraghi N, Maffeis M, Rossi M, et al. Slow breathing improves arterial baroreflex sensitivity and decreases blood pressure in essential hypertension. Hypertension 2005; 46(4): 714-8.
Cipriano GF, Cipriano G, Jr., Santos FV, Guntzel Chiappa AM, Pires L, Cahalin LP, et al. Current insights of inspiratory muscle training on the cardiovascular system: a systematic review with meta-analysis. Integr Blood Press Control 2019; 12: 1-11.
Calcaterra V, Vandoni M, Correale L, Larizza D, DeBarbieri G, Albertini R, et al. Deep breathing acutely improves arterial dysfunction in obese children: evidence of functional impairment. Nutr Metab Cardiovasc Dis 2014; 24(12): 1301-9.
Sleight P. Lowering of blood pressure and artery stiffness. Lancet 1997; 349(9048): 362.
Kim S, Kyung C, Park JS, Lee SP, Kim HK, Ahn CW, et al. Normal-weight obesity is associated with increased risk of subclinical atherosclerosis. Cardiovasc Diabetol 2015; 14: 58.
Gardner AW, Parker DE. Arterial elasticity in american indian and caucasian children, adolescents, and young adults. Vasc Med 2011; 16(4): 275-83.
Naik GS, Gaur GS, Pal GK. Effect of modified slow breathing exercise on perceived stress and basal cardiovascular parameters. Int J Yoga 2018; 11(1): 53-8.
Babb TG. Obesity: challenges to ventilatory control during exercise--a brief review. Respir Physiol Neurobiol 2013; 189(2): 364-70.
Ferreira JB, Plentz RD, Stein C, Casali KR, Arena R, Lago PD. Inspiratory muscle training reduces blood pressure and sympathetic activity in hypertensive patients: a randomized controlled trial. Int J Cardiol 2013; 166(1): 61-7.