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African Journal for Physical, Health Education, Recreation and Dance (AJPHERD)
Volume 18, No. 4(1), (December), 2012, pp. 787-794.
Body composition variation following diaphragmatic breathing
B.S. SHAW1, I. SHAW1,2 AND G.A. BROWN3
1Department of Sport, Rehabilitation and Dental Sciences, Tshwane University of Technology,
Private Bag X680, Pretoria, Gauteng, 0001, Republic of South Africa
2Office of the Deputy Pro Vice-Chancellor: Research, Monash South Africa, P.O. Box X60,
Ruimsig, 1725, Republic of South Africa and Department of Sport, Rehabilitation and Dental
Sciences, Tshwane University of Technology, Private Bag X680, Pretoria, Gauteng, 0001,
Republic of South Africa
3University of Nebraska at Kearney, Human Performance Laboratory, HPERLS Dept, Kearney,
Nebraska, 68849, United States of America
(Received: 2 September 2012; Revision Accepted: 20 October 2012)
Abstract
Overweight and obesity has been linked to an impaired pulmonary function. The incidence of
overweight has grown to more than 1 billion people globally, possibly explaining the increased
prevalence of asthma which has increased by ~47% in the last decade. As such, the aim of the
study was to determine the effect of commonly prescribed diaphragmatic breathing training on
the body composition of asthmatics. Forty-four sedentary, moderate persistent asthmatics were
randomly assigned to either a non-exercising control (NE) group (n = 22) or diaphragmatic
breathing (DB) group. The DB group trained three times weekly for eight weeks using
inspiratory and expiratory training in a semi-recumbent position at varying inspiration: expiration
ratios. Eight weeks of DB had a significant impact on body mass (p = 0.001), %BF (p = 0.001),
fat mass (p = 0.001) and lean body mass (p = 0.009), while WHR (p = 1.000) and BMI
(p = 0.134) did not significantly improve from the pre- to post-test. No significant changes were
found in the body mass (p = 0.512), BMI (p = 0.087), %BF (p = 0.442), WHR (p = 0.303), fat
mass (p = 0.857) and lean body mass (p = 0.635) of the NE group. These findings demonstrate
the health benefits of diaphragmatic breathing in assisting in the prevention of obesity and
especially reducing or preventing the accumulation of abdominal adipose tissue in moderate
persistent asthmatics.
Keywords: Asthma, breathing retraining, overweight.
How to cite this article:
Shaw, B.S., Shaw, I. & Brown, G.A. (2012). Body composition variation following
diaphragmatic breathing. African Journal for Physical, Health Education, Recreation and Dance,
18(4:1), 787-794.
Introduction
Asthma is a chronic disease that has grown from affecting 160 million
individuals in 2000 to now affecting 235 million individuals (Lai et al., 2003;
Rabe et al., 2000; Rabe et al., 2004; World Health Organization (WHO), 2012).
While asthma is a detrimental and debilitating disease, countries across the globe
are calculating the economic cost of asthma on their countries. Further, asthma
788 Shaw, Shaw and Brown
reduces quality of life and an adult’s lifetime productivity with adult asthmatics
missing an average of 5.7 days of work annually. While economic costs vary, it
is estimated that the lifetime economic costs of asthma for all asthmatics born in
the year 2000 is US$7.2 billion of which US$3.2 billion is for medical costs and
US$4 billion is the loss in productivity (Corso & Fertig, n.d.).
Compounding the burden of asthma is the growing incidence of obesity.
Globally, there are more than 1 billion overweight adults and 520 753 350
million of them are clinically obese with obesity rates having risen at least three-
fold since 1980 (Worldometers, 2012). Since obesity has been linked to an
impaired pulmonary function (Guerra et al., 2002; Spector & Surette, 2003) this
may possibly explain the increased prevalence of asthma. According to Canoy et
al. (2004), this could possibly be due the inability of the respiratory muscles, and
more specifically the diaphragm, to function adequately under the layer of
abdominal fat. It has also been suggested that the weight of the abdominal
viscera may influence the chest-wall configuration by detracting its bases
inferiorly (Baum & Wolinsky, 1989). Further, when the chest-wall is larger than
the lung at the apex and the opposite at the bases, the lung will have to be
overexpanded at the superior portion to fill the chest cavity and compress at the
inferior portion to follow the local chest-wall configuration (Baum & Wolinsky,
1989).
In this regard, forced expiratory volume in one second (FEV1) is linearly related
to waist-to-hip ratio (WHR) while forced vital capacity (FVC) is inversely
related to WHR. Further, asthmatics with abdominal obesity are more prone to
have impaired respiratory function when compared to those asthmatics without
abdominal obesity (Canoy et al., 2004). A relationship has also been found
between body-mass-index (BMI) and asthma since individuals with a BMI of 28
kilogrammes per square metre (kg.m-2) or more have been found to display an
increased risk of developing asthma (Guerra et al., 2002). Females with a BMI
in the lower tertile are also at a significantly higher risk of developing asthma
(Real et al., 2006). Interestingly, female asthmatics are generally classified as
pre-obese or obese possibly explaining the relationship between elevated BMI
and asthma risk (Guerra et al., 2002).
As such, in order to curb or slow the progression of asthma and concomitant
chances of developing obesity, exercise regimes need to be well-designed and
appropriate to the condition. One of the most popular exercise training modes
that asthmatics follow is breathing retraining, currently known as diaphragmatic
breathing, most likely due to its specificity and ease. In this regard,
diaphragmatic breathing increases the involvement of the diaphragm during
inspiration, compresses the abdominal contents which increase intra-abdominal
pressure that causes lateral transmission of pressure to the lower ribs laterally,
upward and outward motion of the lower ribs and anterior/posterior motion of
Body composition and diaphragmatic breathing 789
the upper ribs which results in an increase in thoracic volume that decreases
intrathoracic pressure which facilitates inspiration (Cahalin et al., 2002;
Gibbons, 1992). Diaphragmatic breathing is thus essential to an asthmatic since
asthmatics perform thoracic type breathing and since dyspnea can cause the
asthmatic to increase inspiration further leading to further overextension of the
already over-inflated lungs. Despite vast research demonstrating the effects of
diaphragmatic breathing on various pulmonary function-related variables
(Bouchard et al., 1993; Cahalin et al., 2002; Vitacca et al., 1998), little or no
research has been conducted on the effects of diaphragmatic breathing on body
composition. As such, the aim of the study was to determine the effect of
diaphragmatic breathing on the body composition of asthmatics.
Methods
Sample
Forty four, sedentary subjects who met the criteria of moderate-persistent asthma
based on the National Institute of Health (NIH) guidelines (60-80% of predicted
FVC, FEV1 and/or PEF) (National Institute of Health (NIH), 2006), were
randomly assigned into either a non-exercising control (NE) group (n = 22) or
diaphragmatic breathing (DB) group (n = 22). The subjects were also required to
be non-smokers, had no influenza-like symptoms two to three weeks prior to the
study, had daily asthmatic symptoms, had nocturnal asthmatic symptoms more
than once a week and a peak flow variability of more than 30%. The study was
approved by the Institutional Review Board at the University of Johannesburg,
South Africa and was conducted in accordance with the ethical standards and the
Helenski Declaration of 1975 (revised in 1983) on human experimentation. All
subjects gave written informed consent and were allowed to discontinue from the
study at any time if they wished. Subjects were instructed not to take part in any
other physical activity during the study. The descriptive characteristics of the
groups are presented in Table 1. When the groups were compared, no
statistically significant differences (p > 0.05) were found for age, stature, body
mass and forced vital capacity (FVC).
Table 1: Descriptive characteristics of diaphragmatic breathing (DB) and non-exercising control
(NE) groups
Variables
Diaphragmatic breathing
(DB) group
(n = 22)
Non-exercising control
(NE) group
(n = 22)
Age (years)
21.93 ± 3.95
21.90 ± 3.89
Stature (centimetres)
168.66 ± 7.53
169.37 ± 10.68
Body mass (kilogrammes)
75.18 ± 12.66
76.05 ± 13.95
Forced vital capacity (FVC) (liters)
3.01 ± 0.58
2.82 ± 0.57
Values are presented as means ± SD
790 Shaw, Shaw and Brown
Anthropometric measurements
All subjects underwent an identical battery of tests before and after the eight-
week intervention period. All subjects were evaluated in the post-absorptive state
following a nine to 12 hour fasting period (Jenkinson, 1992). Anthropometric
measurements were carried out according to the methods proposed by the
International Society for the Advancement of Kinanthropometry (ISAK) (Norton
& Olds, 1996). Subjects were weighed in kilogrammes (kg) (to the nearest 0.1
kg) on a calibrated digital medical scale (Seca 843, Switzerland) wearing
minimal clothing and no shoes. Each subject’s stature was measured in
centimetres (cm) (to the nearest 0.1 cm) via a standard wall-mounted
stadiometer. Each subject’s body mass and stature were used to calculate BMI
which was defined as the ratio of body mass to stature squared, expressed as
kg∙m-2. Percentage body fat (%BF) was calculated by utilising the seven skinfold
method of Jackson and Pollock for males (Jackson & Pollock, 1978) and females
(Jackson et al., 1980). Skinfolds were measured using a manual skinfold calliper
(Harpenden John Bull, British Indicators Ltd., England). Waist and hip
circumferences were taken with the subject standing, by wrapping the tape at the
level of the narrowest point between the lower costal (10th rib) border and the
iliac crest. Hip circumference was taken at the level of the greatest posterior
protuberance of the buttocks which usually corresponds anteriorly to about the
level of the symphysis pubis. Waist-to-hip ratio (WHR) was calculated using the
following formula: WHR = waist circumference (cm)/hip circumference (cm).
Fat mass was calculated by multiplying body mass with body fat percentage
which was divided by 100. Lean mass was calculated as total body mass in
kilogrammes subtracted by fat mass in kilogrammes. Anthropometric
measurements were carried out three times by a single tester. The mean of the
three measures was utilised in the data analysis.
Protocol
Subjects in the DB group were required to perform a five minute warm-up
consisting of easy walking at a heart rate of less than 100 beats per minute (Clark
et al., 2000) and concluded with two sets of 30 seconds using six stretching
exercises for the major muscle groups (Alter, 1990). The DB programme
consisted of inspiratory and expiratory training in a semi-recumbent position
with posterior pelvic tilting, knees flexed and neck extended (Cahalin et al.,
2002). This was achieved by inspiring and expiring maximally through a 10
centimetre (cm) tube which was 1 cm in diameter principally using abdominal
motion, while reducing upper rib cage motion and having the nose blocked.
Subjects were required to stabilise a 2.5 kg (weeks 1-4) or a 5 kg weight (weeks
5-8) onto the abdominal cavity. The subjects were required to maintain eye
contact with a second-timer clock while exercising in order to maintain the pace
Body composition and diaphragmatic breathing 791
of the exercises effectively. The subjects had to complete three sets of five to 10
repetitions using one second of inspiration and two seconds of expiration
(1:2 inspiration to expiration ratio) (Shaw et al., 2010; Singh et al., 1990), three
sets of 10 to 15 repetitions of a 2:4 inspiration to expiration ratio and three sets
of 15 to 20 repetitions of a 3:6 inspiration to expiration ratio with a 60-90-second
rest periods in between each set (Shaw et al., 2010). The exercise sessions were
concluded with a five-minute cool-down consisting of walking at a heart rate of
less than 100 beats per minute (Clark et al., 2000). The subjects in the NE group
were instructed to maintain their normal daily activities throughout the eight-
week experimental period and received no structured exercise programme.
Statistical analysis
Statistical analysis consisted of a Levene’s test to determine the homo- or
heterogeneity of the variables between the groups at pre-test. Descriptive
statistics and differences at pre- and post-tests between the groups were analysed
using a paired samples t-test. Data are presented as mean ± SD and alpha levels
were set at 0.05 to determine significance. Statistical analyses were performed
using commercially available software (Statistical Package of Social Sciences
(SPSS) Version 14; Chicago, IL).
Results
At pre-test, the NE and DB was homogeneous in terms of their body mass
(p = 0.882), BMI (p = 0.987), %BF (p = 0.181), WHR (p = 0.811), fat mass
(p = 0.208) and lean body mass (p = 0.126).
Table 2: Pre- and post-test body composition responses to diaphragmatic breathing (DB)
Variable
Non-exercising control (NE)
group
(n = 22)
Diaphragmatic breathing (DB)
group (n = 22)
Pre-Test
Post-
Test
p-value
Pre-Test
Post-
Test
p-value
Body mass (kg)
76.05
± 13.95
76.26
± 14.33
0.512
75.18
± 12.66
73.96
± 12.61
0.000*
Body mass index
(BMI) (kg.m
-2
)
26.51
± 4.55
26.58
± 4.78
0.087
26.43
± 3.73
26.00
± 3.95
0.134
Percentage body fat
(%BF)
21.96
± 11.53
21.64
± 11.39
0.442
16.34
± 6.65
12.30
± 5.96
0.000*
Waist-to-hip ratio
(WHR) (cm)
0.828
± 0.078
0.831
± 0.086
0.303
0.811
± 0.060
0.810
± 0.059
1.000
Fat mass (kg)
17.74
± 12.20
17.52
± 11.77
0.857
12.13
± 6.61
9.28
± 5.57
0.000*
Lean body mass (kg)
58.31
± 8.36
58.75
± 8.69
0.635
63.05
± 10.51
64.68
± 10.55
0.009*
792 Shaw, Shaw and Brown
Values are presented as means ± SD; *: Statistically significant (p ≤ 0.05); kg: kilogrammes;
kg.m-2: kilogrammes per square meter; cm: centimeters
Eight weeks of DB had a significant impact on body mass which decreased by
1.62% (p = 0.000), %BF which decreased by 24.72% (p = 0.001), fat mass which
decreased by 23.50% (p = 0.001) and lean body mass which increased by 2.59%
(p = 0.009). On the contrary, DB training did not significantly result in changes
in WHR (p = 1.000) and BMI (p = 0.134) from the pre- to post-test.
No significant changes were found in the body mass (p = 0.512), BMI
(p = 0.087), %BF (p = 0.442), WHR (p = 0.303), fat mass (p = 0.857) and lean
body mass (p = 0.635) of the NE group subjects.
Discussion
The principle findings of this study demonstrated that eight weeks of
diaphragmatic breathing effectively improved four of the six body composition
measures in moderate persistent asthmatics, including body mass, %BF, fat mass
and lean body mass. Certainly it is well known that sedentary individuals tend to
improve their body composition at faster rates than individuals who are already
physically active (Westcott & Guy, 1996), which could account for the
improvements in body composition. Further, diaphragmatic breathing could have
impacted inter alia muscular performance and muscle morphology due to an
increase in muscle mass as demonstrated by the improved lean mass.
The improvements in body composition translates not only into benefits of
improved body fatness for the asthmatic but weight loss has been found to
improve forced expiratory volume in one second (FEV1) and forced vital
capacity (FVC) (Lazarus et al., 1997). Wannamethee et al. (2005) reiterated this
by demonstrating that %BF is inversely related to both FEV1 and FVC.
Therefore, the decrease in fat mass and %BF could have improved abdominal
and chest wall excursion and placed the diaphragm at a mechanical advantage.
This could have been achieved by improving the diaphragm’s descent into the
abdominal cavity and by reducing the intra-abdominal adipose that pressed
upward on the diaphragm. Consequently, this would then improve range of
movement and compliance, the work of breathing and elastic recoil.
This study is significant for demonstrating decreases in body composition
following diaphragmatic breathing even in the absence of dietary restriction.
This is promising because asthmatics can perform their normally prescribed
diaphragmatic breathing without dietary restriction. Of particular importance is
that this study found a reduction in most of the measured body composition
variables using diaphragmatic breathing which could be sustained by sedentary
moderate persistent asthmatics and provides evidence that moderate persistent
asthmatics do not have to perform other activities to manage their body
composition that could exacerbate their asthmatic symptoms.
Body composition and diaphragmatic breathing 793
These findings lay the groundwork for determining the long-term health benefits
of diaphragmatic breathing assisting in the prevention of obesity and especially
reducing or preventing the accumulation of abdominal adipose tissue in
moderate persistent asthmatics.
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