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Cátia Paixão, Ana Tavares, and Alda Marques

activities of daily living (ADLs), such as personal hygiene, eating, and dressing ( Mitchell et al., 2009 ; Pathan et al., 2011 ). These impairments contribute to a decrease of respiratory function and physical activity participation ( Hesseberg et al., 2016 ), and quality of life, thus increasing

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Roy J. Shephard

Aging leads to a progressive deterioration of lung function, including a decrease of vital capacity, an increase of residual volume, a tendency for the airways to collapse during expiration, enlargement of all components of the respiratory dead space, a poor mixing of inspired gas, poor matching of ventilation with perfusion, a decrease of pulmonary diffusing capacity, and a substantial increase in the work of breathing. Ventilatory demand is increased during most physical tasks, but arterial blood homeostasis is surprisingly well maintained when elderly persons undertake vigorous exercise because peak cardiac output declines in parallel with the loss of ventilatory function. However, dyspnea progressively restricts peak effort as one ages. The exercise specialist cannot restore aged or damaged pulmonary tissue but can attempt to reduce the rate of future functional loss by encouraging smoking cessation, avoiding air pollution, and controlling acute infections. Enhanced fitness, stronger skeletal muscles, and better coordination can reduce ventilatory demand. Resisted breathing exercises may also strengthen the chest muscles and allow a mechanically more efficient pattern of breathing.

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Mark L. Watsford, Aron J. Murphy, Matthew J. Pine, and Aaron J. Coutts

Older adults’ participation in habitual exercise might be affected by alterations to respiratory mechanics such as decreased respiratory-muscle strength. This reduction can cause a decrease in efficiency of the ventilatory pump, potentially compromising exercise participation. This research examined the role of habitual exercise in respiratory-muscle function and the associated implications for exercise performance. Seventy-two healthy older adults (36 men, 64.9 ± 8.6 years, 177.2 ± 8.4 cm, 82.5 ± 11.9 kg; 36 women, 64.9 ± 9.5 years, 161.7 ± 6.4 cm, 61.6 ± 9.2 kg) undertook respiratory-function and walking-performance tests. Active men and women achieved higher scores than their inactive counterparts for all tests except spirometry, where no differences were evident. The results indicate that a significant amount of the elevated fitness level might be accounted for by increased endurance capacity of the inspiratory muscles. Inactive older individuals might be at risk for inadequate respiratory-muscle strength, so interventions should be considered.

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Andrew Cox, Marcie B. Fyock-Martin, and Joel R. Martin

suggested that the ETM may be beneficial for improving respiratory function. 5 , 6 Figure 1 —Flow diagram of the search process. Table 1 Characteristics of Included Studies Authors Characteristics Maher and Figueroa 6 Porcari et al. 5 Biggs et al. 7 Warren et al. 8 Study design RCT RCT RCT RCT Participants

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Fumi Hirayama, Andy H. Lee, and Tetsuo Hiramatsu

Background:

Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. Because only 20% of cigarette smokers develop COPD, certain environmental and lifestyle factors may protect against the disease development.

Methods:

To investigate the relationship between life-long physical activity involvement and the COPD risk, a case-control study was conducted in central Japan. A total of 278 eligible patients (244 men and 34 women) age 50 to 75 years were referred by respiratory physicians, while 335 controls (267 men and 68 women) were recruited from the community. All participants underwent spirometric measurements of lung function. Information on demographic and lifestyle characteristics was obtained by face-to-face interview using a structured questionnaire.

Results:

Older adults who remained physically active had better lung function than others inactive over the life course. The COPD patients were found to be less active than their healthy counterparts. Significant reductions in risk of COPD and breathlessness were evident by being active life-long, with adjusted odds ratio 0.59 (95% CI 0.36−0.97) and 0.56 (95% CI 0.36−0.88), respectively.

Conclusions:

The study suggested an inverse association between life-long physical activity and the risk of COPD and breathlessness. Promotion of physical activity to prevent this major disease should be encouraged.

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Luca Cavaggioni, Athos Trecroci, Damiano Formenti, Luke Hogarth, Massimiliano Tosin, and Giampietro Alberti

The purpose of this study was to monitor the changes in breathing pattern, trunk muscle stabilization, and upper-body muscular power in Paralympic swimmers throughout a competitive season over three time points: October (T1), March (T2), and August (T3). Six top-level Paralympic swimmers voluntarily participated in this study. The Friedman test, the Bonferroni–Dunn multiple comparison post hoc analysis, and Kendall’s W concordance coefficient for the measure of effect were used. A significant difference was found in the breathing pattern, trunk stability, and upper-body power variables from the T1 to T3 season (p < .05). However, no significant changes were found in the T2 season. A long-term assessment of these fitness parameters may be of practical importance for better tailoring the training programs of top-level Paralympic swimmers.

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Leila Ahmadnezhad, Ali Yalfani, and Behnam Gholami Borujeni

of warm-up with an ergometer with a constant speed and resistance and 3 min of full-body stretching movements). Table 2 The Result of Respiratory Function and Pain Intensity Before and After IMT Variables Group BT Mean (SD) AT Mean (SD) F (WG) P (WG) F (BG) P (BG) Effect size, d VC Training 3

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Han-Kyu Park, Dong-Woo Kim, and Tae-Ho Kim

have reported that the abdominal muscles are indispensable to postural control and respiratory function in daily life. 14 , 15 , 19 , 20 Athletes in a variety of sport activities (eg, running, swimming and diving, and cycling) are using respiration training more often. 21 – 23 Numerous researchers

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Barton E. Anderson and Kellie C. Huxel Bliven

Clinical Scenario:

Research has shown a link between poor core stability and chronic, nonspecific low back pain, with data to suggest that alterations in core muscle activation patterns, breathing patterns, lung function, and diaphragm mechanics may occur. Traditional treatment approaches for chronic, nonspecific low back pain focus on exercise and manual therapy interventions, however it is not clear whether breathing exercises are effective in treating back pain.

Focused Clinical Question:

In adults with chronic, nonspecific low back pain, are breathing exercises effective in reducing pain, improving respiratory function, and/or health related quality of life?

Summary of Key Findings:

Following a literature search, 3 studies were identified for inclusion in the review. All reviewed studies were critically appraised at level 2 evidence and reported improvements in either low back pain or quality of life following breathing program intervention.

Clinical Bottom Line:

Exercise programs were shown to be effective in improving lung function, reducing back pain, and improving quality of life. Breathing program frequencies ranged from daily to 2–3 times per week, with durations ranging from 4 to 8 weeks. Based on these results, athletic trainers and physical therapists caring for patients with chronic, nonspecific low back pain should consider the inclusion of breathing exercises for the treatment of back pain when such treatments align with the clinician’s own judgment and clinical expertise and the patient’s preferences and values.

Strength of Recommendation:

Grade B evidence exists to support the use of breathing exercises in the treatment of chronic, nonspecific low back pain.

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Filipa Cardoso, Eduardo P. Coelho, Ana Gay, João Paulo Vilas-Boas, João C. Pinho, David B. Pyne, and Ricardo J. Fernandes

Wearing an intraoral jaw-protruding splint could enhance respiratory function in clinical settings and eventually exercise performance. Purpose: The authors studied the acute effect of wearing a lower-jaw-forwarding splint at different protruding percentages (30% and 50%) across a wide range of running exercise intensities. Methods: A case study was undertaken with a highly trained and experienced 27-year-old female triathlete. She performed the same incremental intermittent treadmill running protocol on 3 occasions wearing 3 different intraoral devices (30% and 50% maximum range and a control device) to assess running physiological and kinematic variables. Results: Both the 30% and 50% protruding splints decreased oxygen uptake and carbon dioxide production (by 4%–12% and 1%–10%, respectively) and increased ventilation and respiratory frequency (by 7%–12% and 5%–16%, respectively) along the studied running intensities. Exercise energy expenditure (approximately 1%–14%) and cost (7.8, 7.4, and 8.0 J·kg−1·m−1 for 30%, 50%, and placebo devices, respectively) were also decreased when using the jaw-protruding splints. The triathlete’s lower limbs’ running pattern changed by wearing the forwarding splints, decreasing the contact time and stride length by approximately 4% and increasing the stride rate by approximately 4%. Conclusions: Wearing a jaw-protruding splint can have a positive biophysical effect on running-performance-related parameters.