The Need for Breathing Retraining: the Elephant in the Cardiac Rehabilitation Room
Condition: Chronic Heart Failure
MeSH terms: Heart Failure
Study type: Interventional

Summary: 
      As an extension of previous work, in this study, a breathing retraining component is added
      using breathing calisthenics and inspiratory muscle trainer for the classical cardiac
      rehabilitation (CR), as an appealing option, to implement a comprehensive rehabilitation
      protocol addressing the different patient-centered outcomes including different
      cardiovascular, and respiratory complaints; increasing the benefits of classical CR;
      detecting the impact of adding this on the cardiovascular (CV) outcomes, and discovering the
      correlation between the CV and respiratory data.
    

Detailed description: 
      A very large number of studies have demonstrated the positive effect of cardiac
      rehabilitation (CR) and pulmonary rehabilitation (PR) on morbidity and mortality. Globally,
      each year millions of patients with different cardiovascular diseases (CVD) and chest
      diseases are enrolled in these programs. The exact effects may be slightly variable, but
      generally, both CR and PR aim to improve the patient's condition and improve the overall
      quality of life utilizing almost the same methods (exercise, and education).

      Despite these positive effects, utilization rates of either CR or PR are around 30% in
      Europe, with much less percentages in the Middle East. The reasons for the low engagement
      rates are many; with most probably the main reasons are about individuality and reach.
      Optimized CR programs have to be individually tailored; meeting the individual needs of every
      single patient in the program. Worse knowing that the chest pain and breathlessness are
      highly prevalent in general in CVD, and considered -in many cases as the chief complaint, and
      the classical CR programs are neglecting these complaints; negatively affecting adherence
      rates and patient-centered outcomes (PCO) which mostly extend much beyond the cardiovascular
      complaints, to extend to the respiratory, and sleep complaints; questioning the reason why
      breathing retraining methods are not yet considered as an integral part of the CR programs.

      The reason that standard CR programs usually neglect these complaints, and only look for the
      CV outcomes; is considering the other mentioned complaints as "out-of-context". However,
      solid evidence is suggesting a strong correlation between respiratory, sleep, and CV
      outcomes.

      It has been previously investigated the impact of the CR on sleep, and there is a prior
      estimate suggesting that 25% of the participants in the CR programs have already sleep
      disorders, there is a strong correlation between the sleep and CV outcomes, and almost all of
      the patients in the CR have respiratory symptoms including dyspnea and functional capacity
      decline.

      Therefore, it was suggested adding a breathing retraining component using breathing
      calisthenics and inspiratory muscle trainer for the classical CR, as an appealing option, to
      implement a comprehensive rehabilitation protocol addressing the different PCO including
      different cardiovascular, and respiratory complaints; increasing the benefits of classical
      CR; detecting the impact of adding this on the CV outcomes, and discovering the correlation
      between the CV and respiratory data.
    

Intervention name(s): Cardiac rehabilitation with breathing retraining; Cardiac rehabilitation
Intervention type(s): Behavioral; Behavioral
Intervention description(s): A cardiac rehabilitation program for 3 days/week (day after day) for 12 weeks(including aerobic, and resisted exercise, with educational sessions, and counseling), with a breathing retraining (using breathing calisthenics, and inspiratory muscle training); A cardiac rehabilitation program for 3 days/week (day after day) for 12 weeks(including aerobic, and resisted exercise, with educational sessions, and counseling) only
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Care Provider)
Primary purpose: Treatment
Keywords: chronic heart failure; inspiratory muscle training; cardiac rehabilitation