Effect of Breathing Exercise on Certain Physiological Parameters, Sleep Quality and Vitality in Elderly
Phase: NA
Conditions: Breathing, Sleep Disorder
Sponsor: Aysun Erdal

Official Title of the study: Effect of breathing exercise on some 
physiological parameters, sleep quality and vitality in elderly.
NCT number: not yet have 
Date of the document: January 1, 2019

Description of the clinical study
The present study was planned to examine the effect of a breathing exercise intervention, which
was administered to the elderly residents of a nursing home in Ankara, on some physiological
parameters, sleep quality and vitality. Breathing exercises can be performed at any time of the
day. Due to the effect of some breathing exercises on sleep status, it is not recommended to be
applied close to sleeping at night. It is important to evaluate the physical environment in terms
of environmental stimuli such as sound, heat, and light, as it affects focusing during breathing
exercise. No special clothing or materials are needed during breathing exercises. In order to
make the exercise more understandable and fun, various materials have been used in some
studies  (balloon,  wind  rose,  etc.).  In  the  literature,  there  are  study  results  showing  that
physiological  effects  are  seen  as  a  result  of  applying  respiratory  exercise  to  the  elderly
individuals for three months, three days a week, 30 minutes, in small groups.
Breathing exercises can be done in different ways. Below are the features of the most frequently
applied respiratory breathing exercises.
Pursed Lip Exercise: This exercise reduces the number of breaths by keeping the airways open
longer. It increases the amount of air flow to the lungs. To apply, it is enough to breathe through
the nose and give the lips by contracting. Breathing should be like blowing a candle. The
exhalation period should be extended by double the breathing time.
Diaphragmatic  Breathing  Exercise:  The  diaphragmatic  breathing  exercise  shows  its
effectiveness by helping this muscle stretch to work more effectively. While sitting comfortably
or  lying  down,  one  hand  is  placed  on  the  chest  and  the  other  hand  on  the  abdomen,  it  is
necessary to feel that the abdomen moves out by breathing through the nose. If the abdomen
moves more than the chest, the activity is done correctly. Exercise should be repeated as much
as possible during the day.
Cough Exercise: Cough exercise is a breathing exercise designed to effectively get rid of mucus
without the need to feel very tired. In some individuals, it can create a sense of inhibition when
coughing  mucus.  In  a  comfortable  sitting  position,  after  taking  and  breathing  two  normal
diaphragm breaths, the third one is breathed and the breath is given twice by making “huh huh
sound”. This breathing should be like blowing into a mirror to allow the mirror to evaporate.
Cough exercise should be less tiring than a traditional cough
Research hypotheses
H01:  There  is  no  difference  in  lung  functions  between  the  intervention  group  of  elderly
individuals subjected to breathing exercises, and those in the control group.
H02: There is no difference in cardiac functions between the intervention group of elderly
individuals subjected to breathing exercises, and those in the control group.

H03:  There  is  no  difference  in  sleep  quality  between  the  intervention  group  of  elderly
individuals subjected to breathing exercises, and those in the control group.
H04: There is no difference in subjective vitality between the intervention group of elderly
individuals subjected to breathing exercises, and those in the control group.
Study design and participants
The  study  was  planned  in  a  pre-test–  post-test,  randomized  controlled  (parallel)  and
experimental design. The study will include individuals aged 65 years and older residing in a
nursing home in Ankara, who had a Mini Mental Test score of ≥2415, had no acute or chronic
lung diseases, and had no physical/mental disabilities or limitations and conditions16,17 that
might present any obstacle to participate in breathing exercises.
In order for the elderly to perform breathing exercise, he / she should not have acute or chronic
lung disease, cognitive functions, physical / mental disability or restriction and disease that
would prevent them from participating in respiratory exercise. Especially; ear, brain, spinal
cord surgery, acute retinal hemorrhage vertebral fracture and diaphragmatic rupture, hiatus or
abdominal hernia, acute myocardial infarction, unstable angina pectoris, severe coronary artery
disease,  congestive  heart  failure,  severe  heart  valve  disease,  acute  myocarditis,  acute  and
breathing exercises are not recommended for diseases and health problems such as unstable
musculoskeletal injuries, uncontrolled systemic hypertension, severe dementia and behavioral
disorders. While examining the inclusion criteria, information about the health status of elderly
individuals will be obtained from the files of the nursing home's health unit, and the mini mental
test will be applied by the researcher. 
After the ethical and institutional permits are obtained for the implementation of the study, the
elderly individuals (except the mini metal test score) meeting the researcher nursing home will
be identified on 21.01.2019 and the mini mental test measurements of the elderly individuals
will  be  made  in  the  library  of  the  nursing  home  between  22.01.2019  -28.01.2019.  Elderly
individuals who agree to participate in the study will be identified by informing the appropriate
individuals about the study. In addition, if any of these situations occur during the exercise
program, the researcher will be informed by the health unit and the elderly individual will be
separated from the study.
Clinical trial facility location and property    
The research was carried out in the 75th Year Nursing Home Elderly Care and Rehabilitation
Center, affiliated to Ankara Family and Social Policies Provincial Directorate. The institution,
which has a capacity of 294 people, has a director and three deputy directors, 10 nurses, three
social  workers,  two  psychologists  and  a  sociologist  and  four  physiotherapists.  Breathing
exercises program is not included in the routine practices of the nursing home. In addition,

activities such as hobby works, handicrafts, music studies, sports activities, exhibitions and
kermes activities, excursions, cinema days, panel - conferences are carried out. Exercise will be
held in the group activity hall of the physical therapy unit, which is determined as the most
suitable  area  for  elderly  individuals  and  exercise  application  with  the  joint  decision  of  the
nursing home management and researcher.
Prevention of interaction of groups
In order to reduce the interaction of elderly individuals in the intervention and control groups
with respect to breathing exercise, the exercise room of the physical therapy unit located in a
different area than the section where the elderly live is determined as the application area of the
exercise. In addition, even if there is a sharing about breathing exercise among elderly, the
application should be applied regularly and consciously under the supervision of a specialist in
order to reveal the desired success. In this sense, it is thought that the interaction between the
groups has no significant effect.
Pre-test
The pre-test application is planned to be done between 29.01.2019 -03.02.2019. In the physical
therapy unit of the nursing home, a suitable area will be determined by the researcher and
specialist physiotherapist, and measurement devices will be placed, elderly individuals in both
groups will be called from the room phone and called for measurement. In order to prevent the
data from being affected by the measurements, introductory information data sheet, Pittsburg
Sleep Quality Index, Subjective Vitality Scale will be applied, individuals will be rested during
this period, and then cardiological parameters will be evaluated, and finally lung functions will
be evaluated.
A  manual  sphygmomanometer  and  a  pulse  oximeter  device  will  be  used  to  assess  heart
function. Sphygmomanometer is of Perfect Aneroid type. The manometer chamber and the
spoon spoon are nickel plated chrome. The manometer is 48 mm in diameter, the cuff outer
cloth dimensions are 13x47 cm (+/- 2 cm), the cuff outer cloth is hooked, the cuff inner tube
hoses are made of double-layer, vulcanized rubber. It is suitable for adult use. Finger pulse
oximetry device has arterial oxygen saturation and pulse measurement feature. It provides a
graphical view of the pulse. It is suitable for all ages. Evaluation steps are as follows;
• The individual is informed before evaluating his heart functions.
•  The  individual  is  placed  in  a  position  where  the  individual  can  be  comfortable  from  the
measurement. He should not have used tea, coffee and cigarettes until 15 minutes before the
measurement.
• The individual is rested for 3-5 minutes
• Heart rate is measured from the radial artery for one minute

• For the systolic / diastolic blood pressure, the appropriate arm is selected, the clothes are
relaxed / removed, the arm is positioned (must be at 45 ° heart level), the appropriate sleeve is
selected (wrap the arm sufficiently). Next, the location of the brachial artery is determined, the
air of the cuff is completely evacuated, the lower edge of the cuff is taken 2-2.5 cm above the
place where the brachial artery is palpated, the middle point of the cuff is placed on the brachial
artery. The receiver of the stethoscope is placed on the brachial artery without touching the
sleeve and clothes and the earpiece is placed on the ear, the cuff is inflated to 30 mmHg above
the previously determined systolic blood pressure value, then the cuff air is discharged to be 2-3
mmHg / second.
•  Blue,  black,  green,  brown,  red  nail  polish,  if  any,  in  the  individual  before  the  oxygen
saturation measurement is deleted, artificial nail is removed,
• It is placed on the hand and / or toenail of the light source part of the pulse oximeter,
• Measurements are made for 30 seconds and then the device is removed from the finger 
• The data are recorded on the data form created by the researcher.
Evaluation of lung functions will be done in the presence of a specialist physiotherapist. The
specialist physiotherapist does not know the elderly individuals in the experimental and control
groups. Spirometry will be used to evaluate lung function. Spirometry is the basic device of
respiratory function test laboratories. It consists of the electronic part where the measurement is
made and the mouthpiece that the patient breathe. Cosmed Pony FX - Desktop Spirometer and
disposable mouthpieces suitable for the device will be used in the study. This type of spirometer
enables  testing  without  the  need  for  a  computer.  It  has  an  internal  memory  where  patient
information can be stored. It is used with two-way digital turbine flowmeter. Pulse function test
measurement application steps are as follows;
• Elderly individuals are informed before spirometry is applied.
• The height of the elderly person, body weight is measured and recorded with his age
• Individual disposable mouthpiece is placed in the entry section of the tool.
• The individual puts the mouthpiece in his mouth with his lips, but not to bite with his teeth. It
is  important  that  the  lips  close  well.  Otherwise,  leakage  will  occur.  This  causes  incorrect
measurement.
• The nose of the individual who is connected to the spirometer device with the help of a
mouthpiece is closed with a special latch before the measurement.
• The individual breathes calmly first (4-5 times)
• It takes a hard, deep and fast breath after normal breathing.
• It is also fast, challenging and exhaled with the command to exhale. Breathing should take at
least 6 seconds.
• This process must be repeated at least 3 times.
The test results are compared with the expected values (predicted values) pre-calculated in
healthy individuals of the same age, height and gender by the software found in the spirometer

device and expressed as a percentage of these values. The obtained results will be sent to the
researcher within 15 days in pdf format by the authorized firm of the spirometer device.
Application steps in the intervention group
The  literature  has  been  examined  in  determining the duration of respiratory exercise to be
applied to elderly individuals in the study group. Taking into consideration the methods and
suggestions  of  all  these  studies,  respiratory  exercises  are  planned  in  this  study.  Breathing
exercises;  Between  18.02.2019  -09.05.2019,  for  12  weeks,  three  days  a  week  (Monday,
Tuesday, Thursday) in groups of 5-6 people (2 groups of 6 people, 4 groups of 5 people in total,
10.00-15.30 hours) between each group at the same time of the day, 30 min. will be applied for
a  while.  During  the  breathing  exercise,  no  special  clothing  or  supplies  will  be  needed.
Disruptions in participating in the exercise program will be compensated for at the specified
time and day in partnership with the elderly individual and the researcher. The wind rose to be
used during the exercise will be provided by the researcher. All types of breathing exercises will
be taught to older individuals on the first day of application and will be shown again by the
researcher prior to the application throughout the application. Dizziness that may occur during
breathing  exercise  may  occur.  Elderly  individuals  will  be  reminded  of  this  before  each
application, and if they experience dizziness, they will be asked to wait for the dizziness to pass
by pausing the exercise for a short time. The application of the breathing exercise program is as
follows;
I. Pursed Lip Breathing Exercise (using the Wind rose)
• The individual is seated in a position where he feels comfortable and with clothes,
• First, breathe slowly through the nose,
• Lips contract like a whistle
• The wind rose is kept at the level of the mouth at a distance of 25 cm,
• The breath is discharged slowly and for a longer period of time (at least twice the breathing)
by blowing from the shrunken lips to the wind rose,
• Power should be used to exhale,
• This process continues until the breath is interrupted,
• A break is taken for 30 seconds, then the procedure is repeated (Total 10 minutes)
• 2 minutes break.
II. Diaphragmatic breathing exercise
• The active hand is placed on the stomach and the other hand on the chest,
• Breathing slowly through your nose,
• The abdomen is filled with air and the hand rises,
• The rib cage should rise less than the abdomen,
• Then, breathing slowly through the mouth,

• 30 seconds break and the process is completed (10 minutes in total),
• 2 minutes break.
III. Cough exercise
• Then a deep breath is taken through the nose,
• After the chest is fully enlarged, mouth is exhaled,
• This process is repeated twice,
• Take a deep breath for the third time and hold it for 2 seconds,
• Then, two times, "huh huh" sound is made and the mouth is exhaled,
• 30 seconds break,
• Then this process is repeated (Total 10 minutes).
Application steps in the control group
No breathing exercise will apply to elderly in the control group. Individuals will continue their
daily lives.
Post-test
One day after the end of breathing exercise application, between the dates 10.05.2019 -
14.05.2019, elderly individuals will be called by calling from the room telephones in the 
physical therapy unit. will be re-evaluated in individuals in both groups