Changes in Dyspnea, Activity and Sleep in COPD by Video-Based Breathing Exercises

March 17, 2026 updated by: Ayfer Bayındır Çevik, Bartın Unıversity

The Effect of Video-Based Breathing Exercises Taught to COPD Patients on Dyspnea Severity, Activity Level, and Sleep Quality

Chronic Obstructive Pulmonary Disease (COPD) is one of the most prevalent and high-mortality chronic diseases worldwide. Symptoms such as dyspnea, cough, sleep disturbances, fatigue, restricted activity levels, anxiety, and depression develop in COPD patients, negatively affecting their quality of life. Dyspnea, associated with various symptoms in COPD patients such as reduced activity levels and sleep disturbances, is a significant issue. Therefore, effective management of dyspnea will contribute to reducing other important problems associated with COPD.

One of the non-pharmacological methods used in managing these symptoms associated with COPD is breathing exercises. Particularly, pursed-lip breathing exercises and diaphragmatic breathing exercises are recommended for symptom management in COPD patients in the literature.

The aim of this study was to learn the effects of video-based breathing exercises (pursed lips and diaphragmatic breathing) training given to COPD patients over 18 years of age on the severity of dyspnea experienced by the patient, activity level and sleep quality. The main question it aims to answer is:

Does the use of video-based breathing exercises for 30 days result in a decrease in dyspnea severity and an increase in activity level and sleep quality in COPD patients over 18 years of age? Patients will receive video-based breathing exercises lasting approximately 5-7 minutes and will perform the breathing exercises regularly for 30 days, keep a diary and receive follow-up messages (sms). Afterwards, dyspnea severity, activity level and sleep quality will be assessed again, both in the group itself and in comparison with the control group that did not receive this education and follow-up.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

Chronic Obstructive Pulmonary Disease (COPD) stands as a prominent progressive chronic condition, with approximately 210 million individuals affected globally, placing it third in terms of global mortality. COPD is recognized as a widespread, preventable, and manageable ailment marked by ongoing airflow restriction linked to chronic inflammation triggered by harmful gases and particles. Patients with COPD commonly experience symptoms like shortness of breath, coughing, disrupted sleep, fatigue, limited physical activity, as well as feelings of anxiety and depression.

Nurses play a crucial role in evaluating and addressing symptoms in COPD patients. They can utilize non-pharmacological techniques such as respiratory exercises, progressive relaxation exercises, reflexology, and yoga to help manage and alleviate dyspnea. Pursed-lip breathing, deep breathing, and diaphragmatic breathing exercises are commonly recommended for controlling hyperventilation and addressing dyspnea in COPD patients. Pursed-lip breathing has been shown to lower respiratory rate, decrease carbon dioxide levels, and increase oxygen levels and tidal volume in COPD patients. Additionally, diaphragmatic breathing exercises have been found to boost tidal volume and oxygen levels while reducing respiratory rate in COPD patients.

Sleep problems develop in 40% of COPD patients. Dyspnea in COPD patients often leads to sleep disturbances. Additionally, cough and sputum-induced insomnia affect daily life activities in COPD patients. Adequate sleep has a positive effect on respiratory and gas exchange functions in respiratory system diseases. Therefore, managing dyspnea in COPD patients will also reduce their sleep problems.

Physical activity level is associated with mortality in COPD patients. Furthermore, it has been reported that good physical activity reduces the severity of COPD-related symptoms and improves quality of life. Factors such as dyspnea, lung capacity, and inflammation negatively affect activity levels in COPD patients. Studies in the literature suggest that physical exercise programs rather than respiratory exercises increase physical activity levels in COPD patients.

In conclusion, while studies in the literature report positive effects of respiratory exercises on dyspnea management, no studies examining the effect of respiratory exercises on sleep quality and physical activity were found. This study is planned to investigate the effect of pursed-lip breathing exercises and diaphragmatic breathing exercises on dyspnea severity, activity level, and sleep quality in COPD patients.

Research Method:

The study is planned as a randomized controlled design.

Data Collection Tools:

  • 6-minute walk test:This test is used to evaluate functional capacity by measuring the distance walked within a certain period of time. In the 6-minute walk test, the patient walks as fast as possible, but without running, in a straight corridor of 30 meters. The distance walked is measured. During the test, the patient should not change their pace or speed. It is known that patients with poor 6-minute walk test results have a poor prognosis.
  • Patient Information Form: In the form created in line with the literature information; socio-demographic information of the participant, information about the disease and other chronic diseases, medications used, and habits are obtained.
  • Modified Borg Scale (MBS)
  • Saint George Respiratory Questionnaire (SGRQ)
  • Asthma and COPD Sleep Scale

Data Collection:

Patients receiving treatment for COPD at Bartın State Hospital Chest Diseases Service will form the sample. Patients who meet the inclusion criteria for the study will be randomized using a computer-assisted randomization system. Informed Voluntary Consent Form will be obtained from patients who agree to participate in the study, and then the Patient Information Form, Modified Borg Scale, Saint George Respiratory Questionnaire (Activity sub-score), and Asthma and Chronic Obstructive Pulmonary Disease Sleep Scale will be completed. After the pre-test, patients in the experimental group will be taught the pursed-lip breathing exercise and diaphragmatic breathing exercise recommended for COPD patients by the Turkish Thoracic Society. Additionally, patients will be shown a 5-7 minute instructional video prepared by the researchers regarding this. The educational videos will be sent to the researchers' mobile phones via WhatsApp for patients to remember the exercise technique. Patients will be instructed to perform these exercises regularly for 15 minutes three times a day for four weeks. To ensure that patients perform the exercises regularly, an exercise diary will be created and provided to them, and a reminder SMS message will be sent by the researchers at the same time every day. The control group will receive the clinic's routine dyspnea care protocol. After four weeks, final tests will be administered to both groups, and the study will be concluded.

Population and Sample:

The population of the study consists of patients treated with COPD diagnosis at Bartın State Hospital Chest Diseases Service. The sample size was calculated as 56 patients, with 28 in the intervention group and 28 in the control group, taking into account data obtained from a similar study with d=0.68, power=0.80, α=0.05, and β=0.20. Considering that the sample size may decrease due to different reasons in the study, it is planned to have a sample of 60 individuals, with 30 patients in each group.

Dependent and Independent Variables:

Independent variables: Socio-demographic characteristics of patients diagnosed with COPD (Age, gender, education, etc.), respiratory exercises (pursed-lip breathing exercise and diaphragmatic breathing exercise) Dependent variables: Vital signs (respiratory rate, SpO2 value, heart rate, blood pressure), 6-minute walk test, Modified Borg Scale score, Saint George Respiratory Questionnaire (Activity score) score, COPD sleep quality scale

Hypotheses:

H1: The application of respiratory exercises in COPD patients has a positive effect on reducing dyspnea severity.

H2: The application of respiratory exercises in COPD patients has a positive effect on activity level.

H3: The application of respiratory exercises in COPD patients has a positive effect on sleep quality.

Data Evaluation:

The SPSS program will be used for statistical analysis of the obtained data. Descriptive statistical analyses (number, percentage, mean, standard deviation) will be performed for the data. The Shapiro-Wilk test will be used to test whether the data show normal distribution. If the data show normal distribution, paired samples t-test and one-way ANOVA test will be used for matched sets. If the data do not show normal distribution, Kruskal Wallis and Wilcoxon tests will be used. Values with a p-value below 0.05 will be considered statistically significant.

Study Type

Interventional

Enrollment (Actual)

60

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Turkey (Türkiye)
    • Bartın
      • Bartın, Bartın, Turkey (Türkiye), 74100
        • Bartin University

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Adult
  • Older Adult

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  • Individuals aged 18 and above
  • Diagnosed with COPD for at least six months
  • Modified Borg Dyspnea Scale score of at least 3
  • Unable to complete the 6-minute walk test
  • Not previously participated in a respiratory exercise program

Exclusion Criteria:

  • Having cognitive impairment
  • Not willing to participate in the study
  • Failure to perform respiratory exercises regularly
  • Having non-COPD lung diseases such as tuberculosis

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Supportive Care
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Single

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: The group receiving video-based training
Researchers will present a 5-7 minute instructional video aimed at helping participants recall the technique for performing the exercises. These instructional videos will be sent to the researchers' mobile phones via WhatsApp. Participants will be instructed to perform the exercises three times a day for 15 minutes each, for a period of 30 days. To encourage regular exercise, participants will be provided with an exercise diary, and researchers will send reminder SMS messages at the same time every day.
Other: Video-Based Breathing Exercises
Researchers will present a 5-7 minute instructional video aimed at helping participants recall the technique for performing the exercises. These instructional videos will be sent to the researchers' mobile phones via WhatsApp. Participants will be instructed to perform the exercises three times a day for 15 minutes each, for a period of 30 days. To encourage regular exercise, participants will be provided with an exercise diary, and researchers will send reminder SMS messages at the same time every day. The control group will receive the clinic's routine dyspnea care protocol. After thirty days, final tests will be administered to both groups, and the research will be concluded.
No Intervention: The group not receiving video-based training
The control group will receive the clinic's routine dyspnea care protocol. After thirty days, final tests will be administered to both groups, and the research will be concluded.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Modified Borg Scale(MBS) (for dyspnea severity of the COPD patients)
Time Frame: pre-intervention (first measurement)
Dyspnea severity of the COPD patient will be evaluated with Modified Borg Scale(MBS). It was aimed to determine the change in dyspnea severity in COPD patients who received and regularly practiced video-based breathing exercises training. Modified Borg Scale (MBS): As scores increase, dyspnea severity increases (0: None, 0.5: Very, very light, 1: Very light, 2: Light, 3: Moderate, 4: Somewhat severe, 5: Severe, 6: ..., 7: Very severe, 8: ..., 9: Very, very severe, 10: Maximum).
pre-intervention (first measurement)
St. George's respiratory questionnaire (for activity level of the COPD patients)
Time Frame: pre-intervention (first measurement)
30 days of regular breathing exercise was aimed to realize the change in the activity level of patients with COPD. The change in activity level will be measured by Saint George's Respiratory Questionnaire (SGRQ). Saint George's Respiratory Questionnaire (SGRQ): The questionnaire consists of 50 items and three subscales: symptoms (8 items), activity (16 items), and impacts of the disease (26 items). Each item in the scale has an empirically determined weight. The questionnaire evaluates respiratory symptoms, activities limited by dyspnea, and the overall impact on daily life. Each subscale of the questionnaire is scored separately, and a total score is calculated. The total score ranges from 0 to 100, where a score of 0 indicates no impairment in quality of life, while a score of 100 indicates a progressive deterioration in quality of life.
pre-intervention (first measurement)
Chronic Obstructive Pulmonary Disease and Asthma Sleep Impact Scale (for sleep qualty of the COPD patients)
Time Frame: pre-intervention (first measurement)
30 days of regular breathing exercise was aimed to realize the change in the sleep qualty of patients with COPD. The Asthma COPD Sleep Scale is a Likert scale consisting of a total of 7 items. A high scale score indicates poor sleep quality and a low scale score indicates good sleep quality. In the scale, scores can range from a minimum of 0 to a maximum of 35. However, the original version of the scale does not specify minimum, maximum, or cut-off scores. A higher total score indicates poorer sleep quality, while a lower total score reflects better sleep quality. Relevant explanations regarding this matter are also provided.
pre-intervention (first measurement)

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Modified Borg Scale(MBS) (for dyspnea severity of the COPD patients)
Time Frame: Last measurement 4 weeks after the first measurement (30 days later)
Dyspnea severity of the COPD patient will be evaluated with Modified Borg Scale(MBS). It was aimed to determine the change in dyspnea severity in COPD patients who received and regularly practiced video-based breathing exercises training. Modified Borg Scale (MBS): As scores increase, dyspnea severity increases (0: None, 0.5: Very, very light, 1: Very light, 2: Light, 3: Moderate, 4: Somewhat severe, 5: Severe, 6: ..., 7: Very severe, 8: ..., 9: Very, very severe, 10: Maximum).
Last measurement 4 weeks after the first measurement (30 days later)
St. George's respiratory questionnaire (for activity level of the COPD patients)
Time Frame: Last measurement 4 weeks after the first measurement (30 days later)
30 days of regular breathing exercise was aimed to realize the change in the activity level of patients with COPD. The change in activity level will be measured by Saint George's Respiratory Questionnaire (SGRQ). Saint George's Respiratory Questionnaire (SGRQ): The questionnaire consists of 50 items and three subscales: symptoms (8 items), activity (16 items), and impacts of the disease (26 items). Each item in the scale has an empirically determined weight. The questionnaire evaluates respiratory symptoms, activities limited by dyspnea, and the overall impact on daily life. Each subscale of the questionnaire is scored separately, and a total score is calculated. The total score ranges from 0 to 100, where a score of 0 indicates no impairment in quality of life, while a score of 100 indicates a progressive deterioration in quality of life.
Last measurement 4 weeks after the first measurement (30 days later)
Asthma Sleep Impact Scale (for sleep qualty of the COPD patients)
Time Frame: Last measurement 4 weeks after the first measurement (30 days later)

30 days of regular breathing exercise was aimed to realize the change in the sleep qualty of patients with COPD. The Asthma COPD Sleep Scale is a Likert scale consisting of a total of 7 items. A high scale score indicates poor sleep quality and a low scale score indicates good sleep quality. In the scale, scores can range from a minimum of 0 to a maximum of 35. However, the original version of the scale does not specify minimum, maximum, or cut-off scores. A higher total score indicates poorer sleep quality, while a lower total score reflects better sleep quality. Relevant explanations regarding this matter are also provided.

The effect of video-based breathing exercise training and regular practice on sleep quality will be measured with the same measurement tool (Asthma and Chronic Obstructive Pulmonary Disease Sleep Scale).
Last measurement 4 weeks after the first measurement (30 days later)

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Bartın Unıversity

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

June 20, 2024

Primary Completion (Actual)

December 20, 2025

Study Completion (Actual)

March 17, 2026

Study Registration Dates

First Submitted

June 4, 2024

First Submitted That Met QC Criteria

June 21, 2024

First Posted (Actual)

June 27, 2024

Study Record Updates

Last Update Posted (Actual)

March 18, 2026

Last Update Submitted That Met QC Criteria

March 17, 2026

Last Verified

March 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • BartınU_Bayındır Cevik_001

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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