BREATHING

EXERCISE
Dr. AARSH BHATT (PT)
CARDIO-RESPIRATORY
DISORDERS
MUSCLES OF RESPIRATION 2
MECHANISM OF RESPIRATION 3
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WHAT IS BREATHING ?
 VENTILATION : Process of moving air in and out of the
lungs is called ventilation

 BREATHING : Process that delivers oxygen and

removes carbon dioxide is called breathing
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BREATHING
EXERCISE
 Breathing exercises, also known as respiratory
exercises or pulmonary rehabilitation exercises, refer to
a variety of techniques and practices aimed at
improving the function and efficiency of the respiratory
system.

 These exercises typically focus on enhancing lung

capacity, improving breathing patterns, and optimizing
the exchange of oxygen and carbon dioxide within the
body.
GOALS OF BREATHING
EXERCISE
1. Improved Oxygenation:
2. Enhanced Lung Function
3. Stress Reduction and Relaxation
4. Enhanced removal of secretions
5. Improved Circulation
6. Enhanced Respiratory Muscle Strength
7. Detoxification
8. Regulation of pH Levels
9. Improved Focus and Concentration
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INDICATIONS CONTRAINDICATIONS

• Cystic Fibrosis • Severe Pain & Discomfort

• COPD • Acute Medical or Surgical

• Atelectasis Emergency

• Pneumonia • Severely Impaired GCS

Level
• Post SCI
• Unstable Head & Neck Injury
• Post Surgical Rehab
• Flail Chest
• Relaxation
• Uncontrolled Hypertension

• Recent Meal within 2 hours

TYPES OF BREATHING
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EXERCISE
 DIAPHRAGMATIC BREATHING

 PURSED LIP BREATHING

 GLOSSOPHRYNGEAL BREATHING

 SEGEMENTAL BREATHING
DIAPHRAGMATIC
BREATHING
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INTRODUCTION

 Diaphragmatic breathing exercises are traditionally

performed to improve ventilation, decrease the work of
breathing, mitigate dyspnea, normalize breathing
pattern, and reduce the incidence of postoperative
pulmonary complications.

 Potential beneficial effects include improvements in tidal

volume, abdominal motion, pulmonary function,

respiratory rate, and arterial blood gases.

TECHNIQUE
 Have the patient attain position that optimizes DB (e.g., sitting supported,
semi-Fowler position).
 Patients with COPD with marked hyperinflation of the lungs and a
paradoxical breathing pattern, sitting with trunk flexion is recommended
 It has been suggested that posterior pelvic tilt may facilitate DB and that
internal rotation and adduction of the upper extremities may inhibit upper
chest motion
 Provide tactile stimulation by placing one hand on the patient’s abdomen
over the umbilicus and the other on the upper chest while asking the
patient to breathe slowly and comfortably.
 Follow the patient’s breathing with the hands and note the movement of
the abdomen versus the upper chest.
 Normally, the lower hand will rise with inspiration as the diaphragm
pushes the abdominal contents down and fall with expiration as the
diaphragm returns to its relaxed position; motion of the upper chest
should be minimal.
 Visual stimulation can be added by having the patient observe increased
motion of the hand over the abdomen and decreased motion of the hand
over the upper chest
 Auditory stimulation can be provided by the therapist through the
provision of loud inspiratory and expiratory sounds corresponding to the
patient’s respiratory cycle
 Monitor several respiratory cycles. As the patient completes an
exhalation, instruct the patient to breathe more deeply with verbal cues
such as “fill my hand with air” or “take a breath into my hand.” Notice the
expansion under the lower hand. Instruct the patient to exhale normally
 If the patient has difficulty with diaphragmatic breathing, instruct him or
her to “sniff” first to promote a diaphragmatic contraction and then to
breathe as described previously, or apply a firm quick-stretch, using the
hand on the abdomen just before inspiration.
 Then have the patient place her/his own hands on the abdomen and
upper chest and repeat the same procedure while following the verbal
cues from the therapist.
 Continue practicing until the patient can demonstrate competency in DB
(e.g., doubling of abdominal tidal excursion with reduced upper chest
excursion and increased tidal volume during DB).
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IN BREATHING RETRAINING, DIAPHRAGMATIC BREATHING

EXERCISES CAN BE PROGRESSED TO HIGHER LEVELS OF
DIFFICULTY BY HAVING THE PATIENT PERFORM THE
EXERCISE WHILE SITTING UNSUPPORTED, STANDING, AND
THEN WALKING, WITH CUES INITIALLY AND THEN
SEQUENTIALLY REMOVING THE VARIOUS CUES

Aarsh’s Tip
Presentation title 17
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PHYSIOLOGICAL EFFECTS
OF DB
PHYSIOLOGICAL 20

EFFECTS
EFFECT ON RESPIRATORY GENERAL BODY
SYSTEM
 Using the diaphragm consciously  Activating the parasympathetic
during respiration increases the lung nervous activity while suppressing the
capacity sympathetic nervous activity [5]
 Improve the efficacy of oxygen  Improving core muscle stability.[6]
ventilation through decreasing the  Helps with relaxation, lowering the
respiratory rate and increasing the tidal harmful effects of the stress hormone
volume cortisol on your body.[4]
 Improving alveolar ventilation by  Increased efficiency of venous return[1]
reducing alveolar dead space and
 Lower your blood pressure[1]
increasing the arterial oxygen
 Coping with the symptoms of post-
saturation
traumatic stress disorder (PTSD)
 Improving blood oxygen levels
PURSED LIP
BREATHING
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INTRODUCTION

 Pursed-lip breathing is a simple technique which

consists of inhaling through the nose and exhaling
through the mouth with pursued lips.
 A patient is instructed to inhale through the nose for
several seconds with the mouth closed and then exhale
slowly over 4 to 6 seconds through lips held in a
whistling or puckered position. This can be done with or
without abdominal muscle contraction
MECHANISM
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Inspire through • Allows the

nose and control of
exhale through oxygenation
and ventilation
mouth

Expiratory • Creates
phase is a back
prolonged pressure

Produces Small
amount of
PEEP
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Inspire through • Allows the

nose and control of
exhale through oxygenation
and ventilation
mouth

Expiratory • Creates
phase is a back
prolonged pressure

Produces Small
amount of
PEEP
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TECHNIQUE
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 The patient should assume a comfortable position as the therapist
describes and demonstrates the technique for PLB and explains its
expected benefits.
With a hand on the patient’s mid abdominal muscles, the therapist
instructs.

 The patient to inhale slowly through the nose.

 The patient is then told to let the air escape gently through the pursed
lips, avoiding excessive use of the abdominal muscles. Giving the patient
a verbal cue, such as “IMAGINE YOU WANT TO MAKE THE FLAME
FLICKER ON A CANDLE THAT IS BEING HELD AT ARM’S LENGTH
FROM YOU,” Will enhance the patient’s understanding and performance.

 The patient is directed to stop exhaling when an abdominal contraction is

detected.

 When able to perform PLB without cues, the patient substitutes their own
hand for the therapist’s hand
SEGEMENTAL
BREATHING
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INTRODUCTION

 Segemental breathing is performed on a segement of

lung or a section of chest wall that needs increased
ventilation or moovement
 Hypoventilation occur in certain areas of the lungs
because of chest wall fibrosis, pain after surgery,
atelectasis , trauma to chest wall, pneumonia and post
mastectomy scar.
TECHNIQUE
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TECHNIQUES
 LATERAL COASTAL EXPANSION
 POSTERIOR BASAL EXPANSION
 RT MIDDLE LOBE OR LINGULA EXPANSION
 APICAL EXPANSION
LATERAL COASTAL
34

EXPANSION
 AKA Lateral basal expansion and may be done uni/bilaterally

 Patient position sitting or hook lying position

 Hand placement : lat aspect of lower ribs

 Ask pt to breath out and feel thr rib cage move downward and inward

 As this continues apply firm downward pressure into the ribs with palm of
your hands

 Just prior to inspiration apply downward and inward stretch to chest.

 This facilitates external intercoastal muscles

 Apply light manual resistance to lower ribs to increase sensory awarness

as pt breaths in deeply

 Pt may be self taught with hand or towel for resistance.

Presentation title 35
Presentation title 36
POSTERIOR BASAL
37

EXPANSION
 This is important for surgical patients who are in bed in semi-reclined
position for an extended period of time

 As secretion often accumulate over the posterior segments of lower lobes

 Have patient sit and lean forward on a pillow , slightly bending the hips.

 Place the PT hand over the posterior aspect of the lower rib and do the
same procedure in lat costal expansion
Presentation title 38
RT MIDDLE LOBE OR
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LINGULA
EXPANSION
 While the patient in sitting place your hand at either the RT or LT side of
pts chest just below the axilla , and follow the same procedure in lateral
coastal expansion
Presentation title 40
APICAL EXPANSION
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GLOSSOPHRYNGEAL
BREATHING
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INTRODUCTION
 Glossophryngeal breathing in which the patient
swallows air into the lungs in order to increase
vital capacity
 GPB is used to augment cough effectiveness,
provide internal mobilization of the chest wall,
and improve quality of life by allowing periods
of ventilator or phrenic nerve stimulator
independence and more effective phonation
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INTRODUCTION
 The patient creates a pocket of negative pressure within the mouth by
dropping the tongue to maximize the internal space, thereby causing air to
be sucked in.

 The patient then closes off his lips and forces the air back and down his
throat with a stroking maneuver of the tongue, pharynx, and larynx
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THANK YOU

.
REFERNCE : Joanne Watchie. Cardiovascular and
pulmonary physical therapy. 2nd edition.