OBJECTIVE: To investigate the effects of a diaphragmatic breathing training program (DBTP) on thoracoabdominal motion and functional capacity in patients with chronic obstructive pulmonary disease. DESIGN: A prospective, randomized controlled trial. SETTING: Academic medical center. PARTICIPANTS: Subjects (n = 30; forced expiratory volume in 1s, 42% +/- 13% predicted) were randomly allocated to either a training group (TG) or a control group (CG). INTERVENTIONS: Subjects in the TG completed a 4-week supervised DBTP (3 individualized weekly sessions), while those in the CG received their usual care. MAIN OUTCOME MEASURES: Effectiveness was assessed by amplitude of the rib cage to abdominal motion ratio (RC/ABD ratio) (primary outcome) and diaphragmatic mobility (secondary outcome). The RC/ABD ratio was measured using respiratory inductive plethysmography during voluntary diaphragmatic breathing and natural breathing. Diaphragmatic mobility was measured by ultrasonography. A 6-minute walk test and health-related quality of life were also evaluated. RESULTS: Immediately after the 4-week DBTP, the TG showed a greater abdominal motion during natural breathing quantified by a reduction in the RC/ABD ratio when compared with the CG (F = 8.66; p < 0.001). Abdominal motion during voluntary diaphragmatic breathing after the intervention was also greater in the TG than in the CG (F = 4.11; p < 0.05). The TG showed greater diaphragmatic mobility after the 4-week DBTP than did the CG (F = 15.08; p < 0.001). An improvement in the 6-minute walk test and in health-related quality of life was also observed in the TG. CONCLUSIONS: DBTP for patients with chronic obstructive pulmonary disease induced increased diaphragm participation during natural breathing, resulting in an improvement in functional capacity.

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