Objective: Slow breathing has favorable acute effects in chronic heart failure (CHF) patients. Aim of this study was to test the feasibility and efficacy of a new nonpharmacological approach to CHF management based on slow breathing training (SBT). Design and method: The study was a cross-over open trial where patients, in random order, underwent a 10–12 week period of SBT with RESPeRATE device (InterCure Ltd., Lod, Israel) and a 10–12 week follow-up under usual care. Patients during SBT were asked to perform each day two separate 15-min sessions of device-guided SBT at a breathing frequency of 6 breaths per minute. In all patients, clinical data collection, echocardiography, polysomnography, 6 minute walking test (6MWT) and laboratory tests were performed at baseline and after each study phase. Results: 74 patients completed the study, with the following baseline characteristics: age 62.9 ± 11.9 years, 59 M/15F, 52 with ischemic CHF, NYHA Class I:7 Class II:51, Class III:16, left ventricular ejection fraction 30.4 ± 8.1 %, hypertension: 47, history of stroke: 5, diabetes: 28. Compared with values before SBT, after completion of the SBT phase we observed an increase in 6MWT distance (from 482.3 ± 118.9 to 499.2 ± 116.9 m; p = 0.008) and in left ventricular ejection fraction [from 30.0 (25.0–37.0) to 32.0 (27.0–37.0) %; p = 0.047], and a decrease in apnea-hypopnea index (from 9.9 ± 10.3 to 7.9 ± 8.4; p = 0.015). A trend towards reduction of pulmonary artery pressure [35 (27–45) vs 32 (25–40) mmHg; p = 0.063] was also seen. Conclusions: Our data indicate that SBT is feasible in CHF patients and that it is associated with an improvement in functional capacity, haemodynamic variables and sleep disordered breathing severity. These results support SBT as a novel and useful component of cardiorespiratory rehabilitation programs in CHF.

Objective: Slow breathing training (SBT) was shown to have favorable acute effects in chronic heart failure (CHF) patients. Aim of this study was to test the influence of SBT on quality of life (QoL) in these patients. Design and method: The study was a cross-over open trial where patients, in random order, underwent a 10–12 week period of SBT with RESPeRATE device (InterCure Ltd., Lod, Israel) and a 10–12 week follow-up under usual care. Patients during SBT were asked to perform each day two separate 15-min sessions of device-guided SBT at a breathing frequency of 6 breaths per minute. In all patients QoL was assessed with Minnesota Living with Heart Failure questionnaire performed at baseline and after each study phase. QoL was assessed both globally and separately for physical, socio-economical and emotional aspects. Results: 74 patients completed the study. with the following baseline characteristics: age 62.9 ± 11.9 years, 59 M/15F, 52 with ischemic CHF, NYHA Class I:7 Class II:51, Class III:16, left ventricular ejection fraction 30.4 ± 8.1 %, hypertension: 47, history of stroke: 5, diabetes: 28. In subjects who completed SBT phase, total and physical QoL scores before and after SBT were 49.0 (41.0–56.0) vs 46.0 (37.5–52.0), p < 0.001, and 22.0 (19.0–25.0) vs. 20.0 (16.0–23.0), p = 0.006, respectively. There were no significant differences in socio-economical [21.5 (17.0–24.0) vs. 21.0 (16.0–23.0); p = 0.200] and emotional [5.0 (3.0–7.0) vs 4.0 (3.0–6.0); p = 0.718] aspects of QoL. Conclusions: Our data indicate that SBT is safe in CHF subjects, and may improve their quality of life, mostly due to an improvement in exercise capacity. These results are in line with our previous finding of increased 6 minute walk distance in this sample, and further support SBT as a novel and useful component of cardiorespiratory rehabilitation programs in CHF.

Objective: Slow breathing has favorable acute effects in chronic heart failure (CHF) patients. Aim of this study is to test the feasibility and efficacy of a new nonpharmacological CHF treatment method based on slow breathing training (SBT). Design and method: The study is an ongoing cross-over open trial where patients, in random order, undergo a 10–12 week period of SBT with RESPeRATE device (InterCure Ltd., Lod, Israel) and a 10–12 week follow-up under usual care. Patients randomized to SBT are asked to perform each day two separate 15-min sessions of device-guided SBT at a breathing frequency of 6 breaths per minute. In all patients, clinical data collection, polysomnography, 6 minute walking test (6MWT), 24-h Holter ECG monitoring, Minnesota quality of life questionnaire and laboratory tests are performed at baseline and after each study phase. Results: Until now 97 pts have entered the study with the following baseline characteristics: age 66.3 ± 10.9 years, 76 M/21F, 43 with ischemic CHF, NYHA Class I: 4, Class II:52, Class III:3, left ventricular ejection fraction 30.1 ± 6.9%, hypertension:23, history of stroke:5, diabetes:16, apnea-hypopnea index (AHI) 10.3 ± 10.5. So far 60 of them have completed the study. No patients had relevant intervention-related adverse events in the course of the study (2 of them underwent CRT pacemaker implantation, 1 had myocardial infarction without time relation to SBT). Compared with baseline values in subjects who completed SBT phase, 6MWT distance (438 ± 126 vs 448 ± 141, p = 0.015) and LV ejection fraction (31.1 ± 6.8 vs 32.8 ± 6.5, p < 0.005) increased; AHI (9.81 ± 9.52 vs 8.1 ± 9.5, p = 0.027) and NYHA scale decreased (1.98 ± 0.35 vs 1.46 ± 0.50, p < 0.001); no significant changes occurred in NT-proBNP (1293 ± 1555 vs 1214 ± 1555, p = 0.92) or BNP (240 ± 173 vs 227 ± 195, p = 0.49). Conclusions: Preliminary data indicate that SBT is feasible and safe in CHF subjects and suggest an improvement in functional capacity and in sleep disordered breathing severity. If these results are confirmed in a larger sample, they may support SBT as a novel and useful component of cardiorespiratory rehabilitation programmes in CHF.

Objective: Slow breathing training (SBT) has been proposed as a new nonpharmacological treatment able to induce favorable effects in chronic heart failure (CHF) patients. However, no information is available regarding its effects on orthostatic blood pressure (BP) changes. Aim of this study was to test the prevalence of orthostatic hypotension (OH) in CHF patients undergoing SBT. Design and method: This analysis was performed in the frame of an ongoing cross-over open trial aimed at assessing the clinical effectiveness of SBT. Patients, in random order, undergo a 10–12 week period of SBT with RESPeRATE device (InterCure Ltd., Lod, Israel) and a 10–12 week follow-up under usual care. Patients randomized to SBT are asked to perform each day two separate 15-min sessions of device-guided SBT at a breathing frequency of 6 breaths per minute. In all patients, before the enrollment and after each phase clinical data collection, BP measurements are performed in supine and standing position. OH is defined as a decrease of > = 20 mmHg in systolic (S)BP or > = 10 mmHg in diastolic (D)BP within 3 minutes of standing. Results: Until now 76 pts have entered the study with the following baseline characteristics: age 64 ± 12 years, 62 M/14F, 29 with ischemic CHF, 39 in NYHA Class II, left ventricular ejection fraction 29.5 ± 7%, 23 with hypertension, 5 with history of stroke, 16 with diabetes. So far 39 of them have completed the study. There were no significant differences in SBP and DBP values in both supine and standing positions among baseline, SBT and control periods (Tab.1). OH prevalence was low and did not change between the phases of the study (3 vs. 2 vs. 3 patients, p = 0.27). The average changes in SBP and DBP after changing position were also not significant: -2.6 ± 12.5 vs –1.2 ± 11.0 vs -2.8 ± 15.3, p = 0.88 and + 3.7 ± 8.5 vs. + 0.9 ± 7.4 vs + 3.7 ± 9.1, p = 0.34 respectively.Conclusions: Preliminary data indicate that SBT is safe and does not affect the prevalence of OH in CHF subjects. If these results are confirmed in a larger sample, they may support the safety of SBT as a novel component of cardiorespiratory rehabilitation programs in CHF.