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Pilot 5


Health Behavior-Related Outcomes with Diaphragmatic Breathing Retraining in Heart Failure Patients

Yaewon Seo, PhD, RN

Yaewon Seo, PhD, RN

Principal Investigator


In heart failure (HF) patients, dyspnea, a key contributor to and the strongest predictor of hospital readmission, along with fatigue, are the primary reasons for modification in function leading to decreased physical activity (PA). Dyspnea and fatigue lead to activity avoidance, subsequent muscle de-conditioning, and further increases of dyspnea at even lower levels of activity. Depression, because of its moderate relationship with both perceived functional status and dyspnea, can further diminish PA and increase disability in activities of daily living (ADLs). Strategies to boost motivation and to minimize or mitigate dyspnea are imperative for improving adherence to PA, and, in turn, improving fatigue, muscle weakness, functional status, disability, and depression. Thus, diaphragmatic breathing retraining (DBR), with a slow breathing pattern, a focus on decreasing dyspnea, and informal caregiver support provides an innovative approach to positively affect the spiraling downward trajectory of HF.

The purpose of this pilot/feasibility study is to evaluate a DBR intervention that incorporates informal caregiver coaching to improve the primary outcomes of dyspnea, fatigue and muscle weakness, and the secondary outcomes of PA, functional status, disability in ADLs, and depression in patients with heart failure. Using an experimental randomized controlled design, 50 participants over 19 years of age, with NYHA Functional Class III/IV, who have a consistent informal caregiver and a telephone, and who reside in a rural area (population less than 2,500), will be recruited at the University of Nebraska Medical Center HF clinic. Both groups will receive the usual care from a HF specialist and telephone calls from a research nurse twice a week at weeks 1 and 2, weekly at weeks 3 and 4, and biweekly until 3 month follow-up. In addition, the experimental group will receive the DBR intervention. The proposed study will provide information about how a DBR intervention will help HF patients to improve outcomes through successful control of dyspnea. With improved outcomes, HF patients are more likely to engage in health promoting activities.


Demographic and Rural Variables Tool

Behavioral Risk Factor Surveillance System Questionnaire-Physical Activity

Actigraph Accelerometer

EQ-5D (Euro-Qol Group measure of health status) 


Ioana Dumitru, MD                    UNMC-COM       idumitru@unmc.edu

Louise LaFramboise, PhD, RN     UNMC-CON        llaframb@unmc.edu

Joseph F. Norman, PhD              UNMC-SAHP      jfnorman@unmc.edu

Bernice Yates, PhD, RN              UNMC-CON        bcyates@unmc.edu