Respiratory conditioning is a controversial area. Some say it cannot be done, others swear by it. Also, the practices of respiratory conditioning are diverse. Everything from diaphragmatic breathing to training at altitude to wearing restrictive training masks are used.
As a basic premise, we should acknowledge that evidence exists that one can strengthen all the muscles used in breathing- the diaphragm and intercostals adapt to stimulation- like any other muscle. Being smooth muscle, it is harder to train the diaphragm, one can’t simply load it like quads and bang out reps.
Instead let’s talk about people with impaired breathing. Chronic Obstructive Pulmonary Disorder (COPD) is a disease found primarily smokers and ex-smokers (most studies cite over 80%). Given the combined nature of having bronchitis and emphysema at all times, their lungs are at all times struggling to maintain sufficient oxygen flow and trying to eliminate carbon dioxide. Chronic bronchitis plugs the bronchial tree with mucus from the mucosal glands and goblet cells. This leads to further inflammation and scarring of the tissue. Emphysema is destruction of the alveoli- the area where air exchange occurs. Thus there are fewer termini where air can exchange. Clearly this population will need whatever training they can get for their lungs.
Yoshimi et al 2012 completed a multi-disciplinary study to help this population improve and self-manage their condition. Patients had their lung function, six minute walk test and a questionnaire completed.
The program included physiotherapy, exercise training, respiratory exercise, education, self-management and nutrition- these were all done with an appropriate professional; physiotherapists, kinesiologists, respiratory therapists, doctors, nurses and nutritionists. This program was done over a 6 week time period, consisting of 2xweek resp. exercise, 2xweek education.
After the 6 weeks program, 6md had improved by an average of 30m- p<.01. TLC, FEV and RC % predicted all improved p <.01. Perceived difficulty dropped from 42 to 32 (out of 100)! Clearly this multi-disciplinary all inclusive approach has major effects immediately. Similar programs are in effects in other respiratory hospitals but information and overall program design could always be refined to improve the number of people who complete the program.
The main question becomes- what is long-term adherence? These are people who as a rule have never been active, never ate healthy and never took care of themselves. Giving them a crash course in the basics in 6 weeks is excellent. Demonstrating improvement across multiple measures of health, fitness and psychological well-being is great. If 2 weeks after the 6 week program is finished, they take on their old habits; we haven’t done what we need to do. I’d love to see a 6 and 12 month follow up to this study. If 50% of the original population is still practicing some form of physical activity 12 months down the road, then we’ve got something that can make a real difference in people’s long-term health. Otherwise, while massively impressive for what it is, the desired societal effect may still be wanting.