Respiratory Resistance Training Increases Vetilatory Capacity in the Elderly

Abstract

Aging is associated with increased breathlessness and declines in respiratory function. These changes may result in decreased exercise with associated consequences on health and quality of life. We hypothesized that respiratory resistance training (RRT) would increase measures of pulmonary function in the elderly.

Methods

15 residents of a retirement community in Richmond, IN (82.2±1.7 years old) received spirometry testing (QRS) at baseline (BL) and were then given a PowerLung "Breather" and instructed to breathe through the device 30 times twice/day. After 9 weeks of RRT, spirometry testing was repeated.

Results

Participants averaged 54±12 breaths per day (~90% compliance) with the device. Maximum Voluntary Ventilation increased with RRT in 11 of 15 participants (47±7 L at BL and 63±9 L at 9 weeks; a 26% increase vs BL, P<0.01). Forced Vital Capacity increased in 12 of 15 participants (from 2.35±0.27 L at BL, to 2.79±0.42 L at 9 weeks; a ~13% increase vs BL, P=0.054). Peak Expiratory Flow Rate increased 21%, from 4.26±0.6 L/s at BL to 4.71±0.58 L/s after 9 weeks of training (p = n.s.). 12 of the 15 participants reported qualitative improvements in the ease with which they breathe and/or decreased breathlessness with exercise.

Conclusion

These data suggest that RRT increases ventilatory capacity in the elderly. These preliminary data suggest that larger trials of RRT in the elderly may be warranted.

Introduction
  • Aging is associated with increased breathlessness/dyspnea, especially with exertion
  • Dyspnea in the elderly may be due to the effects of increased inactivity, heart disease or pulmonary disease.
  • Symptoms of breathlessness may contribute to increasing inactivity with aging, resulting in further respiratory muscle atrophy with aging, resulting in further dyspnea… thus the vicious cycle!
Figure 0
  • Respiratory Resistance Training (RRT) has been shown to increase athletic performance in young healthy individuals1,2.
  • RRT has had beneficial effects in patients with congestive heart failure3 and COPD 4.
  • One previous study5 evaluated the effects of a respiratory training device (inspiratory resistance only) on symptoms of breathlessness with exertion and quality of life perception in healthy elderly individuals.
  • There are no reports on the effects of RRT on spirometric measures in healthy elderly individuals.

Hypothesis

Respiratory Resistance Training will result in pulmonary function improvements in the elderly that are detectable by spirometry.

Methods

Study Participants

  • 17 residents of a retirement community in Richmond, IN volunteered for the study.
  • Average age of the study participants was 82.2±1.7 years old.
  • All study participants received "clearance" to participate from their physicians.
Experimental Design

  • Spirometry was performed at baseline (BL) and then again after 9 weeks of Respiratory Resistance Training (RRT).
  • RRT was with a PowerLung BreatheAir.
  • RRT consisted of 30 breathes with the PowerLung twice/day.
Active Series BreatheAir®
  • Sham PowerLung units (devices that did not provide any resistance but appeared identical to the functioning devices were randomly assigned to some of the participants. It was obvious to the participants with the sham units that they had a sham device because of the lack of resistance with their sham units complained and were given a functioning PowerLung device during the first week of the study. Only two of the sham group stayed on protocol with the sham device. The 15 remaining participants were therefore on functioning PowerLung units for 9 weeks. Because of the "bail-out" from the sham group, individual baseline tests were used as controls.
  • A RRT log/diary was kept by the participants during the study for documentation of exercise level, symptoms of breathlessness, illness, etc.
  • Participants met with a researcher/"coach" every other week throughout the study.

Spirometry

  • Spirometry was performed with the Office Medic (QRS) PC Card spirometer.
  • Tests included:
  • Maximum Voluntary Ventilation (MVV; the max. volume gas moved in 1 min.)
  • Slow vital capacity (SCV)
  • Forced Vital Capacity (FVC)

Results

Figure 1. Protocol Compliance - Compliance averaged 89.3% over the 9 wk protocol. Compliance was determined from the RRT diaries kept by the participants. 100% compliance is 60 breaths/day (20 twice per day).

Figure 1. Protocol Compliance
Compliance averaged 89.3% over the 9 wk protocol. Compliance was determined from the RRT diaries kept by the participants. 100% compliance is 60 breaths/day (20 twice per day).

Figure 2. - Forced Vital Capacity increased with RRT in 12 of 15 participants (~13% increase vs baseline, P=0.054).

Figure 2.
Forced Vital Capacity increased with RRT in 12 of 15 participants (~13% increase vs baseline, P=0.054).

Figure 3. - Peak Expiratory Flow Rate increased 21%, from 4.26±0.6 L/s at BL to 4.71±0.58 L/s after 9 weeks of training (p=n.s.).

Figure 3.
Peak Expiratory Flow Rate increased 21%, from 4.26±0.6 L/s at BL to 4.71±0.58 L/s after 9 weeks of training (p=n.s.).

Figure 4. - Maximum Voluntary Ventilation increased 26% with RRT. 11 of 15 participants had an increased MVV by the study end (47±7 L at Baseline and 63±9 L after 9 weeks of RRT; #P<0.01).

Figure 4.
Maximum Voluntary Ventilation increased 26% with RRT. 11 of 15 participants had an increased MVV by the study end (47±7 L at Baseline and 63±9 L after 9 weeks of RRT; #P<0.01).

12 of the 15 participants reported qualitative improvements in the ease with which they breathe and/or decreased breathlessness with exercise.

Conclusion

These data suggest that RRT increases ventilatory capacity, as determined by MVV, in the elderly. These preliminary data suggest that larger trial of RRT in the elderly may be warranted.

Acknowledgement

The authors are indebted to study participants for their cooperation and commitment to the project. Many thanks to Melissa Russell and Dr. Keith Dobyns of the Richmond Friends Fellowship Community. Thanks to Carolyn Morse, of PowerLung, Inc., who enabled the donation of the "BreatheAir" devices used in this study.

Reprinted with permission from Nathan Trueblood and the Department of Biology, Earlham College