Diaphragmatic Breathing Retraining in Heart Failure Patients: Health-Behavior Related Outcomes
Diaphragmatic Breathing Retraining in Heart Failure Patients: Health-Behavior Related Outcomes
The purpose of this study is to provide information on how the practicing of diaphragmatic
 breathing retraining (DBR) for 8-week at home may improve the health outcomes and encourage
 heart failure patients to engage in health-promoting activities by successfully controlling
 their shortness of breath (dyspnea).
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