The Need for Breathing Training Techniques: The Elephant in the Heart Failure Cardiac Rehabilitation Room: A Randomized Controlled Trial.

BACKGROUND: Although solid evidence has indicated that respiratory symptoms are common amongst patients with chronic heart failure (CHF), state-of-the-art cardiac rehabilitation (CR) programs do not typically include management strategies to address respiratory symptoms. This study investigated the effect of the addition of breathing exercises (BE) to the CR programs in CHF. METHODS: In a two parallel-arm randomized controlled study (RCT), 40 middle-aged patients with CHF and respiratory symptoms were recruited and randomized into two equal groups (n = 20); group (A): standard CR with BE and group (B): standard CR alone. Primary outcomes were respiratory parameters and secondary outcomes included cardiovascular and cardiopulmonary outcomes. All the participants attended a program of aerobic exercise (three sessions/week, 60-75% MHR, 45-55 min) for 12 weeks, plus educational, nutritional, and psychological counseling. Group (A) patients attended the same program together with BE using inspiratory muscle training (IMT) and breathing calisthenics (BC) (six sessions/week, 15-25 min) for the same duration. RESULTS: There was a significant improvement in the respiratory outcomes, and most of the cardiovascular and cardiopulmonary outcomes in both groups with a greater change percentage in group A (p < 0.05). CONCLUSIONS: These results indicate that the addition of BE to the CR programs in CHF is effective and is a "patient-centered" approach.

A randomized comparative study between high-intensity laser vs low-intensity pulsed ultrasound both combined with exercises for the treatment of knee osteoarthritis.

OBJECTIVE: To compare the effects of high-intensity laser therapy (HILT) plus exercise therapy (ET) vs low-intensity pulsed ultrasound (LIPUS) plus ET in knee osteoarthritis (KOA). METHODS: A single blinded randomized controlled trial in an outpatient setting. There were 60 participants with grades II and III KOA based on the radiological findings in Kellgren and Lawrence grading scale. Participants were allocated randomly into three groups, study group I (HILT+ET), study group II (LIPUS+ET), and control (ET) group. Participants in the three groups received active range of motion (ROM) exercises, muscle strengthening, and flexibility exercises. Treatment was administered 5 times/wk for two successive weeks. Primary outcomes involved visual analog scale (VAS), secondary outcomes involved knee ROM, proprioceptive accuracy and Western Ontario and McMaster Universities Arthritis Index scale. All outcomes were measured pre- and post-treatment. RESULTS: The mean age of participants was 55.4 ± 6.34, 55.2 ± 4.77 and 57 ± 6.39 years in HILT+ET, LIPUS+ET and control group respectively. There were statistically significant time-by-group effects (mixed-design multivariate analysis of variance) on all measured outcomes for all groups (P < .0001). However, HILT+ET yielded better improvement than the other groups (P < .0001). Between-group comparison revealed a significant difference in all measured outcomes between study group 1 vs study group 2, and between each study group vs the control group (P = .0001). CONCLUSION: The effect of HILT combined with exercises achieved better results in pain, knee ROM, proprioceptive accuracy and functional disability than LIPUS combined with exercises and both are better than exercises only.