Multiple Breathing Training on Pulmonary Function and Respiratory Muscle Strength in Older Adults

Effects of Multiple Breathing Training on Pulmonary Function and Respiratory Muscle Strength in Older Adults

This study were to investigate the effects of multiple breathing training on pulmonary function, respiratory muscle strength, chest expansion, fractional exhaled nitric oxide (FeNO), aerobic capacity, and dyspnea symptoms in older adults.

Study Overview

• Status: Active, not recruiting
• Conditions: Older Adults (60 - 85 Years Old)
• Intervention / Treatment: Other: Multiple breathing training

Detailed Description

The study included 26 male and female older adults aged 60-75 years, who were divided into a control group (n = 13) that maintained usual daily activities and an experimental group (n = 13) that received multiple breathing training.

The independent variable was multiple breathing training. Dependent variables included lung function (FVC, FEV₁, FEV₁/FVC, MVV), respiratory muscle strength (MIP, MEP), chest expansion, fractional exhaled nitric oxide (FeNO), aerobic capacity, and dyspnea assessment.

• Study Type: Interventional
• Enrollment (Estimated): 26
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Thailand
  • Bangkok
    • Bangkok, Bangkok, Thailand, 10330
      • Faculty of Sports Science, Chulalongkorn University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Older adults aged 60-75 years, both male and female.
• Not regularly physically active (exercising fewer than 2 times per week) during the 6 months prior to the study.
• Cooperative, without communication problems, and able to follow instructions from the trainer.
• No history of cardiovascular disease and no respiratory diseases such as asthma, chronic obstructive pulmonary disease (COPD), etc.
• No hypertension, or if diagnosed with hypertension, it must be well controlled, with resting blood pressure not exceeding 140 mmHg systolic and 90 mmHg diastolic.
• Able to ambulate independently without assistance or assistive devices.
• Willing to participate in the study and able to provide written informed consent.

Exclusion Criteria:

• Any unforeseen events preventing continued participation in the study, such as injury from an accident or illness.
• Attendance of less than 80% of the training sessions (fewer than 19 out of 24 sessions, including the basic training period).
• Withdrawal of consent or unwillingness to continue participation in the study.

Study Plan

How is the study designed?

Design Details

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

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
No Intervention: Control group (Normal daily life)
Experimental: Multiple breathing training; The multiple breathing training program consisted of five structured breathing exercises designed to improve inspiratory muscle strength, expiratory muscle strength, and breath control. Each exercise was performed for three sets, and the total training duration was approximately 40 minutes per session. The program included the following components: Inspiratory Muscle Training (PowerBreathe device): Participants performed resisted inhalation to strengthen the inspiratory muscles (10 repetitions per set). Expiratory Muscle Training (Balloon with control device): Participants exhaled into a balloon while maintaining pressure according to their measured maximal expiratory pressure (MEP) (10 repetitions per set). Inspiratory Training (Tri-Flow device): Participants inhaled through the device to elevate and maintain the floating balls, promoting sustained inspiratory effort (10 repetitions per set). Expiratory Training (Windmill device): Participants exhaled to rotate the windmill,	Other: Multiple breathing training; The multiple breathing training program consisted of five structured breathing exercises designed to improve inspiratory muscle strength, expiratory muscle strength, and breath control. Each exercise was performed for three sets, and the total training duration was approximately 40 minutes per session. The program included the following components: Inspiratory Muscle Training (PowerBreathe device): Participants performed resisted inhalation to strengthen the inspiratory muscles (10 repetitions per set). Expiratory Muscle Training (Balloon with control device): Participants exhaled into a balloon while maintaining pressure according to their measured maximal expiratory pressure (MEP) (10 repetitions per set). Inspiratory Training (Tri-Flow device): Participants inhaled through the device to elevate and maintain the floating balls, promoting sustained inspiratory effort (10 repetitions per set). Expiratory Training (Windmill device): Participants exhaled to rotate the windmill, e

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Forced Vital Capacity; FVC	Participants were seated in a chair and wore a nasal clip during the assessment. They first performed three cycles of slow, normal breathing, followed by a demonstration of forced inspiration and expiration, and then returned to normal breathing.	Change from Baseline FVC at 8 weeks.
Forced Expiratory Volume in One second; FEV1	Participants were seated in a chair and wore a nasal clip during the assessment. They first performed three cycles of slow, normal breathing, followed by a demonstration of forced inspiration and expiration, and then returned to normal breathing.	Change from Baseline FEV1 at 8 weeks.
Maximum Voluntary Ventilation; MVV	Participants were instructed to breathe in and out as quickly and forcefully as possible for 15 seconds.	Change from Baseline MVV at 8 weeks.
Maximal Inspiratory Pressure; MIP	Participants were instructed to exhale fully to functional residual capacity (FRC), then place the mouthpiece securely and perform a maximal inspiratory effort sustained for 1-2 seconds.	Change from Baseline MIP at 8 weeks.
Maximal expiratory pressure; MEP	Participants inhaled fully to total lung capacity (TLC), maintained a tight seal on the mouthpiece, and then performed a maximal expiratory effort for 1-2 seconds.	Change from Baseline MEP at 8 weeks.

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Chest expansion	Participants were instructed to sit upright with their hands placed on their hips. They were then asked to perform a maximal exhalation followed by a maximal inhalation. The researcher measured chest expansion using a measuring tape at the following anatomical levels: upper chest: at the axillary line, midway between the 2nd and 4th ribs, middle chest: at the level of the xiphoid process, midway between the 4th and 6th ribs, and lower chest: at the level of the 10th rib.	Change from Baseline Chest expansion at 8 weeks.
Fraction exhaled nitric oxide; FeNO	FeNO Monitor (BedFont, UK) was used to measure the FeNO. The participants inhaled deeply for 2 to 3 seconds before exhaling slowly, which normally took 10 seconds.	Change from Baseline FeNO at 8 weeks.
Six minutes walk test (6MWT)	They were instructed to walk back and forth along a 30-meter walkway for six minutes at their usual, comfortable pace. The researcher marked the course every 3 meters and placed traffic cones at the turning points. Heart rate was monitored during the test, and the level of perceived exertion was assessed every minute. The total distance walked in six minutes was recorded for analysis.	Change from Baseline 6MWT at 8 weeks.
The University of California, SanDiego Shorthess of Breath Questionnaire (SOBQ)	Participants completed a six-item dyspnea questionnaire before and after the intervention. Each item was rated on a 0-5 scale, with a maximum total score of 30 points. Scores were interpreted as follows: 0-10 indicated no to mild breathlessness, 11-20 indicated mild to moderate breathlessness, and 21-30 indicated moderate to severe breathlessness.	Change from Baseline SOBQ at 8 weeks.

Collaborators and Investigators

• Sponsor: Chulalongkorn University

Publications and helpful links

General Publications

• Jun HJ, Kim KJ, Nam KW, Kim CH. Effects of breathing exercises on lung capacity and muscle activities of elderly smokers. J Phys Ther Sci. 2016 Jun;28(6):1681-5. doi: 10.1589/jpts.28.1681. Epub 2016 Jun 28.
• Gosselink R. Breathing techniques in patients with chronic obstructive pulmonary disease (COPD). Chron Respir Dis. 2004;1(3):163-72. doi: 10.1191/1479972304cd020rs.
• Chung Y, Huang TY, Liao YH, Kuo YC. 12-Week Inspiratory Muscle Training Improves Respiratory Muscle Strength in Adult Patients with Stable Asthma: A Randomized Controlled Trial. Int J Environ Res Public Health. 2021 Mar 22;18(6):3267. doi: 10.3390/ijerph18063267.
• Jansang S, Mickleborough T, Suksom D. Effects of Pursed-Lip Breathing Exercise Using Windmill Toy on Lung Function and Respiratory Muscle Strength in the Elderly. J Med Assoc Thai. 2016 Sep;99(9):1046-51.
• Hess A, Yu L, Klein I, De Mazancourt M, Jebrak G, Mal H, Brugiere O, Fournier M, Courbage M, Dauriat G, Schouman-Clayes E, Clerici C, Mangin L. Neural mechanisms underlying breathing complexity. PLoS One. 2013 Oct 3;8(10):e75740. doi: 10.1371/journal.pone.0075740. eCollection 2013.

Study record dates

Study Major Dates

• Study Start (Actual): November 1, 2025
• Primary Completion (Estimated): March 30, 2026
• Study Completion (Estimated): March 30, 2026

Study Registration Dates

• First Submitted: March 4, 2026
• First Submitted That Met QC Criteria: March 4, 2026
• First Posted (Actual): March 9, 2026

Study Record Updates

• Last Update Posted (Actual): March 9, 2026
• Last Update Submitted That Met QC Criteria: March 4, 2026
• Last Verified: March 1, 2026

More Information

Terms related to this study

• Keywords: Pulmonary function; Respiratory muscle strength; Fractional Exhaled Nitric Oxide; Chest Expansion; Multiple breathing training
• Other Study ID Numbers: EX PHYSIO SPSC 13

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