Efficacy of Alternate Nostril Breathing on Pulmonary Function and Physical Functional Capacity in Healthy Adults Across Different Age Groups: Randomized Control Trial

Year 2024, Volume: 14 Issue: 4, 967 - 973, 29.12.2024

Shilpasree Saha Hina Vaish , Meenu Verma

https://doi.org/10.33808/clinexphealthsci.1337686

Abstract

Objectives: Lung function and functional capacity gradually decline even in asymptomatic individual with age. Alternate nostril breathing (ANB) is a breathing exercise used to modulate the pace of breathing. The present study aimed to evaluate the efficacy of ANB on pulmonary function and physical functional capacity in normal adults across different age groups.
Methods: 48 participants aged 20-50 years were stratified based on age and were assigned into young (experimental and control group) and old age strata (experimental and control group) for this randomized controlled trial. Pulmonary function (FEV₁, FVC, FEV₁/FVC, PIFR, and PEFR) and physical functional capacity (6MWD) were assessed before and after the test. Experimental groups practiced ANB for 15 minutes for 4 weeks (6 days/week) in front of primary researcher. No intervention was given to control groups. Between groups analysis was done by Mann Whitney U test whereas, Wilcoxon signed rank test was used for within group analysis.
Results: Significant differences were found in median values of FEV₁ (2.21-2.47, p=.002), FVC (2.39-2.77, p=.003), PEFR (5.30-6.45, p=.002), and PIFR (3.85-4.22, p=.05) between total experimental and total control groups, but not in FEV₁/FVC ( p=.41 )and PIFR (p=20). Post treatment analysis of total experimental group showed significant improvement in FEV₁ (p= .0001), FVC (p=.0001), PEFR (p= .0001), PIFR (p= .002) and 6MWD (p= .0001), while total control group had no significant improvement in any component (p˃.05).
Conclusion: Alternate nostril breathing can be used as a maneuver to improve age related lung function decrement.

Keywords

Adults, breathing exercise, lung function, peak expiratory flow rate

Ethical Statement

This study was approved by Ethics Committee of Maharishi Markandeshwar Mullana, Haryana, India with ethical number IEC-1365 on 15/03/2019

Supporting Institution

The authors received no financial support for the research

Thanks

We greatly acknowledge the support from all participants and sincerely thank all the subjects for taking part in the study

References

• Roberts MH, Mapel DW. Limited lung function: Impact of reduced peak expiratory flow on health status, health-care utilization, and expected survival in older adults. Am J Epidemiol. 2012;176:127–134. DOI: 10.1093/aje/kwr503.
• Ranu H, Wilde M, Madden B. Pulmonary function tests. Ulster Med J. 2011;80:84-90.
• Doijad VP, Kamble P, Surdi AD. Effect of yogic exercises on aerobic capacity. International Journal of Recent Trends in Science and Technology, 2013;6:119-121.
• Sharma KK, Udaykumara K, Thirmaleshwara PH, Ajithesha NH. Effect of yoga therapy on lung functions in respiratory disorder subjects. Eur Sci J. 2014;10:102-108.
• Khandelwal MK, Maheshwari VD, Garg S, Kumar K, Gupta R, Khandelwal S. Six minute walk distance: Correlation with spirometric and clinical parameters in chronic obstructive pulmonary disease. Int J Healthc Biomed Res. 2013;1:217-226. DOI: 10.7860/JCDR/2015/13181.6311
• Sharma G, Goodwin J. Effect of aging on respiratory system physiology and immunology. Clin Interv Aging 2006;1(3):253–260. DOI: 10.2147/ciia.2006.1.3.253.
• Lutfi MF. The physiological basis and clinical significance of lung volume measurements. Multidiscip Respir Med. 2017;12(3):1-12. DOI: 10.1186/s40248-017-0084-5.
• Chakraborty T, Das K, Samajdar K. Effect of yogic exercise on selected pulmonary function tests in apparently healthy elderly subjects. IOSR J Dent Med Sci. 2013;9 (3):1–5. DOI: 10.9790/0853-0910105.
• Telles S, Sharma S.K, Balkrishna A. Blood pressure and heart rate variability during yoga-based alternate nostril breathing practice and breath awareness. Med Sci Monit Basic Res. 2014; 20: 184–193. DOI: 10.12659/MSMBR.892063.
• Your lungs and exercise. Breathe. 2016;12(1):97-100. DOI: 10.1183/20734735.ELF121.
• Chethan K, Devaraju MR. A study on the effect of Nadi-Shodhana Pranayama on cardiac parameters. Indian J Basic Appl Med Res. 2017;6 (3):126-129.
• Biswas S, Biswas P, Sayyad R, Eliyaraju A, Yadav PK, Kar SK. Effect of forty days of Pranayama training on cardiorespiratory parameters. Indian J Basic Appl Med Res.2014;3(4): 196–202.
• Doijad VP, Surdi AD. Effect of short-term yoga practice on pulmonary function tests. Indian J Basic Appl Med Res. 2012;1(3):226–230.
• Singh S, Gaurav V, Parkash V. Effects of a 6-week nadi-shodhana pranayama training on cardio-pulmonary parameters. J Phys Educ Sport Manag. 2011;2(4):44–47.
• Alaparthi GK, Augustine AJ, Anand R, Mahale A. Comparison of diaphragmatic breathing exercise, volume and flow incentive spirometry, on diaphragm excursion and pulmonary function in patients undergoing laparoscopic surgery: A randomized controlled trial. Minimally Invasive Surgery 2016;2016:1-12. DOI: 10.1155/2016/1967532.
• Ramadan Azab AI S, Moawd S A, Abdul-Rahman R S. Effect of buteyko breathing exercises versus yoga training on pulmonary functions and functional capacity in children with bronchial asthma: A randomized controlled trial. Int J Ther Rehabil Res. 2017;6(1):148-153. DOI: 10.5455/ijtrr.000000234.
• Dhanvijay A D, Dhokne N, Choudhary A K, Kishanrao S S, Chandan L. Effect of alternate nostril breathing on cardiorespiratory variables in healthy young adults. Int J Pharma Bio Sci. 2015;6(2):1352–1360.
• Herawati I, Mat Ludin AF, M M, Ishak I, Farah NMF. Breathing exercise for hypertensive patients: A Scoping Review. Front Physiol. 2023;25(14):1-16. DOI:10.3389/fphys.2023.1048338.
• Bijlani RL, Manjunatha S. Understanding Medical Physiology: A Textbook for Medical Students. 3rd ed. New Delhi: Jaypee Brothers Publishers. 2010.
• Leelarungrayub J, Puntumetakul R, Sriboonreung T, Pothasak Y, Klaphajone J. Preliminary study: Comparative effects of lung volume therapy between slow and fast deep-breathing techniques on pulmonary function, respiratory muscle strength, oxidative stress, cytokines, 6-minute walking distance, and quality of life in persons with C. Int J COPD. 2018; 13: 3909–3921. DOI: 10.2147/COPD.S181428.
• Garg R, Malhotra V, Tripathi Y, Agarawal R. Effect of left, right and alternate nostril breathing on verbal and spatial memory. J Clin Diagnostic Res. 2016;10(2):CC01–CC03.DOI: 10.7860/JCDR/2016/12361.7197
• Dullo P, Vedi N, Gupta U. Improvement in respiratory functions after alternate nostril breathing in healthy young adults. Pak J Physiol. 2008;4(2):15–16.
• Sil A, Kumar P, Kumar R, Das NK. Selection of control, randomization,blinding, and allocation concealment. Indian Dermatol Online J. 2019;10(5):601–605. DOI:10.4103/idoj.IDOJ_149_19.
• Kamath A, Urval RP, Shenoy AK. Effect of alternate nostril breathing exercise on experimentally induced anxiety in healthy volunteers using the simulated public speaking model: A randomized controlled pilot study. Biomed Res Int. 2017;2017:1–7. DOI:10.1155/2017/2450670.
• ATS statement: Guidelines for the six-minute walk test. ATS committee on proficiency standards for clinical pulmonary function laboratories. Am J Respir Crit Care Med.2002;166(1):111–117. DOI: 10.1164/ajrccm.166.1.at1102.
• Frese EM, Fick A, Sadowsky HS. Blood pressure measurement guidelines for physical therapists. Cardiopulm Phys Ther J. 2011;22(2):5–12.
• Agrawal MB, Awad NT. Correlation between six minute walk test and spirometry in chronic pulmonary disease. J Clin Diagnostic Res. 2015;9(8):OC01–OC04. DOI:10.7860/JCDR/2015/13181.6311.
• Naik GS, Gaur GS, Pal GK. Effect of modified slow breathing exercise on perceived stress and basal cardiovascular parameters. Int J Yoga. 2018;11(1):53–58. DOI: 10.4103/ijoy.IJOY_41_16.
• Dhungel KU, Malhotra V, Sarkar D, Prajapati R. Effect of alternate nostril breathing exercise on cardiorespiratory functions. Nepal Med Coll J. 2008;10 (1):25–27.
• David S, Edwards CW. Forced Expiratory Volume.[Updated 2021 Aug 12. In: StatPearls. Treasure Island (FL): 2020
• Budhi RB, Payghan S, Deepeshwar S. Changes in lung function measures following Bhastrika Pranayama (bellows breath) and running in healthy individuals. Int J Yoga 2019;12(3):233‐239. DOI: 10.4103/ijoy.IJOY_43_18.
• Chethan K, Devaraju MR. A study on effect of nadi-shodhana pranayama on respiratory parameters. Indian J Basic Appl Med Res. 2017;6(3):371–374.
• Joshi LN, Joshi VD. Effect of forced breathing on ventilatory functions of the lung. J Postgr Med. 1998;44(3):67-69.
• Singh S, Soni R, Singh KP, Tandon OP. Effect of yoga practices on pulmonary function tests including transfer factor of lung for carbon monoxide (TLCO) in asthma patients. Indian J Physiol Pharmacol. 2012;56(1):63–68.
• Garg S, Chandla SS. Effect of nadi shodhan pranayama on pulmonary functions. Int J Health Sci Res. 2016; 6:192-196.
• Benavides-Pinzón WF, Torres JL. Effects of yoga (pranayama) on lung function and lactate kinetics in sedentary adults at intermediate altitude. Rev. Fac. Med. 2017;65(3):467-472. DOI: 10.15446/revfacmed.v65n3.56310.
• Dinesh T, Gaur GS, Sharma VK, Madanmohan T, Harichandra Kumar KT, Bhavanani AB. Comparative effect of 12 weeks of slow and fast pranayama training on pulmonary function in young, healthy volunteers: A randomized controlled trial. Int J Yoga. 2015;8(1):22–26. DOI: 10.4103/0973-6131.146051.
• Enright PL. The Six-Minute Walk Test. Respir Care 2003;48:783–785.
• Kaminsky DA, Guntupalli KK, Lippmann J, Burns SM, Brock MA, Skelly J, DeSarno M, Pecott-Grimm H, Mohsin A, LaRock-McMahon C, Warren P, Whitney MC, Hanania NA. Effect of yoga breathing (Pranayama) on exercise tolerance in patients with chronic obstructive pulmonary disease: A randomized, controlled trial. J Altern Complement Med. 2017;23 (9):696–704. DOI:10.1089/acm.2017.0102.