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

In heart failure (HF) patients, dyspnea (shortness of breath), a key contributor to and the
strongest predictor of a chief reason for hospital readmission with fatigue, are the primary
reasons for modification in function leading to decreased physical activity (PA). Dyspnea
and fatigue lead to activity avoidance, subsequent muscle de-conditioning, and further
increases of dyspnea at even lower levels of activity. Depression, because of its moderate
relationship both with perceived functional status and 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 weakness, PA itself, functional status, disability, and depression
in HF patients. Thus, diaphragmatic breathing retraining (DBR) or deep breathing with a slow
breathing pattern, a focus on decreasing dyspnea, and mediated by Self-efficacy for DBR and
informal caregiver support during the DBR provide an innovative approach to positively
impact the spiraling effects of HF. The purpose of this pilot/feasibility study is to
evaluate a diaphragmatic breathing retraining (DBR) intervention that incorporates informal
caregiver coaching to improve the primary outcomes of dyspnea, fatigue, and muscle weakness,
and the secondary outcomes of PA, functional status, depression, disability, and depression.

Inclusion Criteria:

- adults age 19 or older who have Class III through IV heart failure as classified by
the New York Heart Association (NYHA)

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

- have a consistent informal caregiver, who is willing to provide support to the
participants, and a telephone

- residing in a rural area (population less than 2,500) (U.S. Census, 1995).

Exclusion Criteria:

- myocardial infarction or coronary bypass surgery within the last three months

- active chest pain

- uncontrolled arrhythmia (atrial fibrillation or ventricular tachycardia)

- on transplant list or has ventricular assist device

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

- history of severe COPD.