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- Ekman, Inger, 1952, et al.
(författare)
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Impact of device-guided slow breathing on symptoms of chronic heart failure: a randomized, controlled feasibility study
- 2011
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Ingår i: European journal of heart failure. - : Wiley. - 1879-0844 .- 1388-9842. ; 13:9, s. 1000-5
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Tidskriftsartikel (refereegranskat)abstract
- AIMS: In many patients with chronic heart failure (CHF) even normal daily life activities cause dyspnoea and fatigue, well-being might be considerably improved by even a modest decrease in such symptoms. The aim of this study was to investigate if lowering breathing rate with the help of a respiratory modulation (RM) device could improve symptoms in patients with CHF. METHODS AND RESULTS: Stable CHF patients with symptoms of dyspnoea were randomized to twice-daily 20 min sessions using an RM device or to music listening (ML) using a CD player, for a 4-week study period. Respiratory modulation guides the user to achieve a slow breathing rate (<10 breaths/min) while increasing exhalation time (Tex) relative to inhalation time (Tin). Lower breathing rate was accomplished by synchronizing respiratory movements with musical tones generated in response to breathing movements monitored with a belt-type sensor. Endpoints were reduced breathlessness and New York Heart Association (NYHA) class. Seventy-two patients (52 male, age 73 +/- 11 years, NYHA 3.1 +/- 0.9) were randomized and 65 completed the study (30 RM and 35 ML, respectively). There was no in-between group improvement in breathlessness and NYHA class. Patients in the RM group who displayed an average increase in Tex/Tin of >0.2 and a reduction in the average respiration rate during 30 sessions were considered responders. Responders reported reduced breathlessness (-0.86 +/- 0.23 units, P < 0.005) and improved NYHA class (-0.64 +/- 0.20, P < 0.01) compared with non-responders. CONCLUSION: Device-guided RM might have the potential to relieve symptoms of heart failure in outpatients by changing their breathing pattern.
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| 2. |
- Norman, Jonna, 1961
(författare)
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Andning och träning i medveten närvaro för personer med hjärtsvikt - studier av erfarenheter och effekter på symtom och tecken, välbefinnande och hälsa
- 2023
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Despite care and treatment, many patients with heart failure (HF) are limited by symptoms, such as shortness of breath (SOB) and fatigue, that is difficult to treat. Research shows that slow breathing and mindfulness-based interventions (MBI) have the potential to reduce stress, improve symptoms and physical functioning, reduce anxiety and depression, and improve quality of life. Few studies have included patients with HF and the knowledge on complementary methods for symptom relief in HF is insufficient. The overall aim of this thesis was therefore to explore the feasibility, experiences and effects of breathing and mindfulness-based training on symptoms and signs, well-being, and health in persons with HF. Moreover, the aim was to gain an understanding of the subjective experiences of breathing, SOB, and management strategies in a stable phase of treated HF. Two interventional studies with randomized design and parallel groups were conducted. Stable, but still symptomatic patients with HF, despite treatment, were enrolled. The studies included one visit before and one after the study period, with repeated measures (Study I, II & III). Study I investigate if slow device-guided breathing (DGB) could improve symptoms in HF. Study II explores the feasibility and effects of MBI on symptoms and signs, and study III secondary outcomes on psychological distress and health. In Study IV, a descriptive design and qualitative content analysis, was applied. Data was collected in semi-structured interviews, using an instrument, Experiences of breathing and shortness of breath (Exp-BeSoB), which was developed in the project. In Study I, there was no improvement in symptoms in the DGB group compared to the music listening (ML) group. Participants in the DGB group, who followed (responders) the DGB and learned to breath in a slow pace and increased the exhaling time, reported significantly improved breathlessness and HF functional class, compared to non-responders. An 8-week MBI, in addition to conventional treatment, significantly reduced the impact of fatigue, symptoms of unsteadiness/dizziness, and breathlessness/tiredness related to physical functioning (Study II). Participants in the MBI-group also reported reduced psychological distress and improved general health. Meanwhile, participants in the control group rated their health lower at follow-up (Study III). Findings in Study IV showed varied experiences of SOB. Participants developed strategies for management of symptoms. Three main categories of experiences were identified: Shortness of breath as a threat to life, Difficulty breathing slows down body and traps mind, and Breathing as no problem and not in mind. Overall, results in this thesis shows good feasibility and applicability for DGB and MBI, as complementary methods to alleviate symptoms in peoples with heart failure. Additionally, MBI, may have the potential to reduce self-reported psychological distress and improve health. The findings help to understand the subjective experiences of SOB and shows the importance of clinicians to be aware of patients’ symptom experiences to initiate breathing intervention. The results are of high clinical relevance hence, larger studies are needed to determine the effects.
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| 3. |
- Norman, Jonna, 1961, et al.
(författare)
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Effects of a mindfulness-based intervention on symptoms and signs in chronic heart failure: a feasibilty study
- 2018
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Ingår i: European Journal of Cardiovascular Nursing. - : Oxford University Press (OUP). - 1474-5151 .- 1873-1953. ; 17:1, s. 54-65
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Tidskriftsartikel (refereegranskat)abstract
- Aims: Despite treatment recommended by guidelines, many patients with chronic heart failure remain symptomatic. Evidence is accumulating that mindfulness-based interventions (MBIs) have beneficial psychological and physiological effects. The aim of this study was to explore the feasibility of MBI on symptoms and signs in patients with chronic heart failure in outpatient clinical settings. Methods: A prospective feasibility study. Fifty stable but symptomatic patients with chronic heart failure, despite optimized guideline-recommended treatment, were enrolled at baseline. In total, 40 participants (median age 76 years; New York Heart Association (NYHA) classification II−III) adhered to the study. Most patients (n=17) were randomized into MBI, a structured eight-week mindfulness-based educational and training programme, or controls with usual care (n=16). Primary outcome was self-reported fatigue on the Fatigue severity scale. Secondary outcomes were self-reported sleep quality, unsteadiness/dizziness, NYHA functional classification, walking distance in the six-minute walk test, and heart and respiratory rates. The Mann–Whitney U test was used to analyse median sum changes from baseline to follow-up (week 10±1). Results: Compared with usual care (zero change), MBI significantly reduced the self-reported impact of fatigue (effect size −8.0; p=0.0165), symptoms of unsteadiness/dizziness (p=0.0390) and breathlessness/tiredness related to physical functioning (NYHA class) (p=0.0087). No adverse effects were found. Conclusions: In stable but symptomatic outpatients with chronic heart failure, MBI alleviated self-reported symptoms in addition to conventional treatment. The sample size is small and further studies are needed, but findings support the role of MBI as a feasible complementary option, both clinically and as home-based treatment, which might contribute to reduction of the symptom burden in patients diagnosed with chronic heart failure.
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