Diaphragmatic Breathing Retraining in Heart Failure Patients: Health-Behavior Related Outcomes

In heart failure (HF) patients, dyspnea is a key contributor to and the strongest predictor
for hospital readmission. In addition, dyspnea and fatigue are the primary reasons for
decreased physical activity (PA) which, in turn, leads to activity avoidance, subsequent
muscle de-conditioning, and further increases of dyspnea even at lower levels of activity.
Depression, because of its moderate relationship with dyspnea, can further diminish PA and
increase disability in activities of daily living (ADLs). Strategies to minimize or mitigate
dyspnea and to boost motivation are imperative for improving adherence to PA, and, in turn,
improving fatigue, muscle strength, PA itself, functional status, disability in ADLs
including basic ADLs and instrumental ADLs (IADLs), depression, and quality of life (QOL) in
HF patients. The overall purpose of this pilot/feasibility study is to evaluate an 8-week,
home-based DBR intervention, in HF patients who are experiencing dyspnea at rest or with
daily activities. Using an experimental randomized controlled design, 50 participants over
19 years of age, with diagnosed with chronic HF, who experience dyspnea at rest or with
activity and experience dyspnea that limits their activities, who have a telephone, and who
reside in a rural area, will be recruited at the University of Nebraska Medical Center HF
clinic and at the Veterans Affairs Nebraska-Western Iowa Hospital, Cardiology-Congestive
Heart Failure clinic. Both groups will receive the usual care from a HF specialist. The
experimental group will receive information on a Diaphragmatic Breathing Retraining (DBR)
intervention whereas the health promotion (attention control) group will receive general
health information. To boost adherence to the intervention and to prevent attrition from the
study, both groups will receive telephone calls from a research nurse for a total of 4
sessions (weeks 1, 2, 4 and 6). During follow-ups via phone calls for the attention control
group, the research personnel will discuss health promotion topics (e.g., lipids profile,
health eating, cancer screening, and annual check-ups (e.g., flu shot, eye and/or dental
exams) with their primary health care provider. Data collection using standardized measures,
will take place at baseline, post-intervention, and 3-month follow-up after completion of
the 8-week intervention. The primary outcomes are: dyspnea and fatigue. The secondary
outcomes are: muscle strength, PA, functional status, depression, disability in ADLs, and
quality of life.

Inclusion Criteria:

1. adults age 19 or older

2. diagnosed with chronic heart failure

3. experiencing shortness of breath at rest or with activities

4. experiencing shortness of breath that limits their activity

5. cognitively intact indicated by being able to describe what participation in the
study will involve

6. have a telephone; AND

7. reside in a rural area either large rural (10,000-49,000 residents), small rural
(2500- 9999 residents), or isolated (< 2499 residents) area

Exclusion Criteria:

1. myocardial infarction or coronary bypass surgery within the last three months

2. active chest pain

3. uncontrolled arrhythmias (atrial fibrillation or ventricular tachycardia)

4. on the transplant list or having a ventricular assist device

5. orthopedic or neurological conditions that would impact muscle strength or interfere
with the 6- minute walk test (6-MWT) (amputation, severe arthritis, Parkinson's,
stroke, or severe neuropathy)

6. history of severe COPD; AND

7. history of sleep breathing disorder