• Users Online: 137
  • Print this page
  • Email this page

 Table of Contents  
Year : 2022  |  Volume : 11  |  Issue : 2  |  Page : 145-148

Effect of respiratory muscle stretch gymnastics on exercise capacity in the elderly – A randomized control trial

1 Department of Cardiovascular and Respiratory Physiotherapy, Sancheti Institute College of Physiotherapy, Pune, Maharashtra, India
2 Post Graduate College, Sancheti Institute of Orthopedics and Rehabilitation, Pune, Maharashtra, India
3 Department of Academic Research, Sancheti Institute of Orthopedics and Rehabilitation, Pune, Maharashtra, India

Date of Submission14-Dec-2021
Date of Decision04-Feb-2022
Date of Acceptance07-Feb-2022
Date of Web Publication08-Apr-2022

Correspondence Address:
Dr. Prajakta Sahasrabudhe
Sancheti Institute College of Physiotherapy, 11/12, Thube Park, Shivaji Nagar, Pune - 411 005, Maharashtra
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijrc.ijrc_163_21

Rights and Permissions

Background: Aging is associated with structural degeneration and functional limitations in the respiratory system, reducing exercise capacity. Respiratory muscle stretch gymnastics (RMSG) is used to improve the function of lungs and respiratory muscles with some success in various populations. Materials and Methods: Eighty-four individuals in the age group of 60–70 years were randomly allocated to the experimental and control group. Individuals in the experimental group were put on a 4-week RMSG supervised program. Distance covered in incremental shuttle walk test (ISWT), maximal inspiratory pressure (MIP), and quality of life (QoL) were the outcome measures for the study. Results: There was an improvement in distance covered in ISWT, MIP, and scores of World Health Organization QoL-BREF (WHO QoL-BREF) questionnaire of subjects in the experimental group (P = 0.000) as compared to the control group. Conclusion: Prescription of RMSG for 4 weeks was beneficial in improving exercise performance, maximal inspiratory muscle strength, and QoL in elderly individuals.

Keywords: Geriatric, incremental shuttle walk test, maximal inspiratory pressure, quality of life, respiratory muscle strength

How to cite this article:
Awachat AC, Sahasrabudhe P, Sancheti P, Shyam A. Effect of respiratory muscle stretch gymnastics on exercise capacity in the elderly – A randomized control trial. Indian J Respir Care 2022;11:145-8

How to cite this URL:
Awachat AC, Sahasrabudhe P, Sancheti P, Shyam A. Effect of respiratory muscle stretch gymnastics on exercise capacity in the elderly – A randomized control trial. Indian J Respir Care [serial online] 2022 [cited 2022 Dec 5];11:145-8. Available from: http://www.ijrc.in/text.asp?2022/11/2/145/342790

  Introduction Top

The respiratory system shows many slow but progressive age-related changes in healthy individuals in lung parenchyma and thoracic cage, and respiratory muscles.[1],[2] These changes include loss of muscle fibers, strength, oxidative capacity, and decreased elastic recoil, hence increased lung compliance, leading to reduced ventilatory reserves available.[3],[4] During periods of illness or increased metabolic demands, reduction of inspiratory muscle performance and increase in the energy expenditure exceed system demands above available reserves resulting in a reduction of exercise tolerance. Respiratory muscle stretch gymnastics (RMSG) is a combination of stretching and breathing used simultaneously, which is proven to be beneficial in improving the function of respiratory muscles in the elderly and patients with chronic obstructive pulmonary disease (COPD). The present study focuses on whether these documented benefits are reflected in actual exercise performance and quality of life (QoL) of elderly individuals.

  Materials and Methods Top


This was a prospective, randomized control trial conducted in a metropolitan city of Maharashtra from March 2020 to September 2021. A break in recruitment was taken from March-end 2020 to October 2020 due to COVID-19 lockdown and higher risks of transmission of COVID to the study population. Few subjects recruited in March 2020 were able to do only a couple of sessions and hence were not considered for data analysis, and these subjects were recruited again to the pool of sample post lockdown. After obtaining ethical approval for the proposal and registration of the trial to Clinical Trials Registry – India (CTRI/2020/12/030149), 84 sedentary individuals between the age group of 60–70 years who have an understanding of the English language and do not have any acute infection, recent illness, or any major cardiovascular, respiratory, metabolic, musculoskeletal, or neurological condition altering health status of the individual were recruited. After obtaining written informed consent, these participants were allocated into two groups randomly using a computer-generated table of random numbers – experimental group (Group A) and control group (Group B).

Baseline assessment of exercise capacity was done for all the participants using the incremental shuttle walk test (ISWT),[5] maximal inspiratory pressure (MIP) using Micro Respiratory Pressure Meter (RPM) machine (CareFusion MicroRPM), and QoL using World Health Organization QoL-BREF (WHO QoL-BREF) questionnaire.[6] All the assessments were done in the participant's home environment or within the residence's premises with the necessary permissions from the residential societies. All anti-COVID-19 measures were taken as per the government guidelines for the safety of participants.[7] Group A participants were started on a supervised exercise protocol consisting of ten repetitions each of five patterns [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5] of RMSG and continued for five times a week for 4 weeks.[8] Each pattern consisted of holding a particular posture with deep inhalation, followed by exhalation and release of the posture. All the sessions were conducted at the participants' homes and supervised personally by the researchers. Participants of Group B were asked to continue their routine activities with no added intervention.
Figure 1: Pattern 1 – Elevating and pulling back the shoulder

Click here to view
Figure 2: Pattern 2 – Stretching the upper chest

Click here to view
Figure 3: Pattern 3 – Stretching the back muscle

Click here to view
Figure 4: Pattern 4 – Stretching the lower chest

Click here to view
Figure 5: Pattern 5 – Elevating the elbow

Click here to view

At the end of 4 weeks, all the Group A and B participants were reassessed at home for parameters assessed at the baseline, and there were no dropouts.

Outcome measures

Distance walked during ISWT – The subjects were asked to walk to and fro on a track of 10 meters, in specified duration, to a set of auditory beeps played on audiotape. With each phase, the expected walking speed was to be increased. The subjects were asked to walk for as long as they could until they were either too breathless, experienced pain in the lower extremity, or could no longer keep up with the beeps of audiotape. The number of shuttles was recorded, and the total distance was calculated.[5]

MIP was measured with Micro RPM device. The subjects were asked to exhale to residual volume, followed by forced inhalation through the device with maximal effort possible held for a minimum of 2 s. The procedure was repeated thrice, and the best reading was recorded.

QoL-World Health Organization (WHO QoL-BREF) scale – QoL scores were assessed for all the individuals using the WHO QoL-BREF questionnaire consisting of 26 questions covering domains such as physical and psychological social health and 37 environmental factors. Individuals were asked to fill out the questionnaire within 10 min.

Statistical analysis

The data collected were analyzed using SPSS version 26 (IBM, Chicago IL USA). The data were tested for normality using the Shapiro–Wilk test. Within-group and between-group comparisons for distance covered in ISWT were done using paired t-test and unpaired t-test, respectively. The within-group data of MIP and WHO QoL (WHO QoL) were analyzed using the Wilcoxon test. Mann–Whitney test was used for MIP and WHO QoL (WHO QoL) between the groups. Nonparametric comparison tests were used for MIP as the values did not present in the normal distribution curve.

  Results Top

Details of the population demographics are explained in [Table 1].
Table 1: Population demographics of Groups A and B

Click here to view

At the end of the intervention period, a statistically significant improvement was found in the distance walked on ISWT, MIP, and WHO QoL scores within Group A as well as on comparison with Group B [Table 2] and [Table 3].
Table 2: Within-group comparison for Groups A and B

Click here to view
Table 3: Comparison between Groups A and B of change in distance covered in incremental shuttle walk test, maximal inspiratory pressure, and World Health Organization Quality of Life

Click here to view

  Discussion Top

There was an improvement in ISWT distance covered by subjects, which measures exercise capacity after performing 4 weeks of RMSG. Various studies have reported changes in ventilatory capacity and chest wall compliance, improved respiratory pattern, and decreased chest wall stiffness. The reduction in functional residual capacity (FRC) following RMSG could thus explain the greater distance walked during the ISWT (P = 0.000). Mistry Hetal et al. found similar results in their study, documenting the improvement in maximum breathing capacity, peak expiratory flow rate, and distance walked in 2-min walk test in elderly individuals.[8] Minoguchi et al. reported a significant improvement in the 6-min walk distance (6MWD) and reduction of FRC in patients with COPD after RMSG training of 4 weeks.[9]

Maintaining optimum respiratory muscle function is vital for normal mechanics. Aging increases diaphragm and intercostal muscle stiffness due to heightened collagen concentration in the diaphragm. RMSG increased the number of sarcomeres that increased the cross-sectional area of the muscle fibers. It increased in functional length of muscle leading to better interaction between the filaments of actin and myosin and improvement in MIP due to enhanced length–tension relationship of muscle fibers with decreased passive tension in inspiratory muscles.[10]

Stretching the contracting muscle is a powerful stimulus for the muscle spindles. According to Kanamaru et al., electromyographic activity from respiratory muscles during RMSG is greater than during deep breathing alone.[11] The present study also reports similar results with increased MIP at the end of 4 weeks RMSG intervention.

WHO QoL-BREF questionnaire contains components that cover the person's physical, social, and psychological aspects.[6] QoL in the elderly is mainly affected due to a decline in exercise capacity and age-related changes in the body's various systems. Improvement in exercise capacity and MIP may lead to better performance of the elderly in their daily activities. Studies have reported that reduction in FRC decreases the dyspnea with RMSG program and causes improvement in well-being allowing overall improvement in QoL. The present study also concluded that there was an improvement in the QoL of elderly people (P = 0.000). However, baseline for this outcome did not match the two groups, so actual change cannot be commented.


The carry-over effect of RMSG was not in view of the study objectives. The convenience sampling strategy was used because of the COVID-19 pandemic, resulting in the inability to generalize the results.

  Conclusion Top

The study concluded that after the practice of RMSG program for 4 weeks by the elderly participants of 60–70 years, there was an improvement in distance covered in ISWT, MIP, and WHO QoL-BREF questionnaire score.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Cohen M. Pulmonary considerations in the older patient. In: Kauffman TL, Barr JO, Moran ML, editors. A Comprehensive Guide to Geriatric Rehabilitation. 3rd ed. London UK: Churchill Livingstone; 2014.  Back to cited text no. 1
Janssens JP. Aging of the respiratory system: Impact on pulmonary function tests and adaptation to exertion. Clin Chest Med 2005;26:469-84.  Back to cited text no. 2
Starr J, Dalton D. The Thorax and Chest Wall. In: Levangie PK, Norkin CC, editors. Joint Structure and Function: A Comprehensive Analysis. 5th ed. Jaypee Brothers Medical Publishers; New Delhi, India: 2011.  Back to cited text no. 3
Krumpe PE, Knudson RJ, Parsons G, Reiser K. The aging respiratory system. Clin Geriatr Med 1985;1:143-75.  Back to cited text no. 4
Singh SJ, Morgan MD, Scott S, Walters D, Hardman AE. Development of a shuttle walking test of disability in patients with chronic airways obstruction. Thorax 1992;47:1019-24.  Back to cited text no. 5
Skevington SM, Lotfy M, O'Connell KA; WHOQOL Group. The World Health Organization's WHOQOL-BREF quality of life assessment: Psychometric properties and results of the international field trial. A report from the WHOQOL group. Qual Life Res 2004;13:299-310.  Back to cited text no. 6
Easing of Restrictions and Phase- Wise Opening of Lockdown. Department of Revenue and Forest, Disaster Management, Relief and Rehabilitation, No: DMU/2020/CR. 92/DisM- 1, Available from: https://www.compfie.com/wp-content/uploads/2020/10/05102020_ACN_03.pdf. [Last accessed on 2020 Sep].  Back to cited text no. 7
Hetal M, Prajakta B. Ashok respiratory muscle stretch gymnastic in elderly: Impact on maximum breathing capacity, peak expiratory flow rate and exercise capacity. Int J Health Sci Res 2020;10:145-58.  Back to cited text no. 8
Minoguchi H, Shibuya M, Miyagawa T, Kokubu F, Yamada M, Tanaka H, et al. Cross-over comparison between respiratory muscle stretch gymnastics and inspiratory muscle training. Intern Med 2002;41:805-12.  Back to cited text no. 9
Matthews PB. Muscle spindles: Their messages and their fusimotor supply. Compr Physiol 2011:189-228. [https://doi.org/10.1002/cphy.cp010206].  Back to cited text no. 10
Kanamaru A, Sibuya M, Nagai T, Inoue K, Homma I. Stretch gymnastic training in asthmatic children. In: Kaneko M, editor. Fitness for the Aged, Disabled, and Industrial Worker. Champaign, Illinois: Human Kinetics Pub; 1990. p. 178-81.  Back to cited text no. 11


  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]

  [Table 1], [Table 2], [Table 3]


Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

  In this article
Materials and Me...
Article Figures
Article Tables

 Article Access Statistics
    PDF Downloaded80    
    Comments [Add]    

Recommend this journal