{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T22:45:53Z","timestamp":1787611553095,"version":"build-2736575974"},"reference-count":39,"publisher":"MDPI AG","issue":"22","license":[{"start":{"date-parts":[[2022,11,9]],"date-time":"2022-11-09T00:00:00Z","timestamp":1667952000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Background: Although solid evidence has indicated that respiratory symptoms are common amongst patients with chronic heart failure (CHF), state-of-the-art cardiac rehabilitation (CR) programs do not typically include management strategies to address respiratory symptoms. This study investigated the effect of the addition of breathing exercises (BE) to the CR programs in CHF. Methods: In a two parallel-arm randomized controlled study (RCT), 40 middle-aged patients with CHF and respiratory symptoms were recruited and randomized into two equal groups (n = 20); group (A): standard CR with BE and group (B): standard CR alone. Primary outcomes were respiratory parameters and secondary outcomes included cardiovascular and cardiopulmonary outcomes. All the participants attended a program of aerobic exercise (three sessions\/week, 60\u201375% MHR, 45\u201355 min) for 12 weeks, plus educational, nutritional, and psychological counseling. Group (A) patients attended the same program together with BE using inspiratory muscle training (IMT) and breathing calisthenics (BC) (six sessions\/week, 15\u201325 min) for the same duration. Results: There was a significant improvement in the respiratory outcomes, and most of the cardiovascular and cardiopulmonary outcomes in both groups with a greater change percentage in group A (p &lt; 0.05). Conclusions: These results indicate that the addition of BE to the CR programs in CHF is effective and is a \u201cpatient-centered\u201d approach.<\/jats:p>","DOI":"10.3390\/ijerph192214694","type":"journal-article","created":{"date-parts":[[2022,11,10]],"date-time":"2022-11-10T01:48:08Z","timestamp":1668044888000},"page":"14694","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["The Need for Breathing Training Techniques: The Elephant in the Heart Failure Cardiac Rehabilitation Room: A Randomized Controlled Trial"],"prefix":"10.3390","volume":"19","author":[{"given":"Abeer","family":"Farghaly","sequence":"first","affiliation":[{"name":"Department of Physical Therapy for Cardiovascular\/Respiratory Disorder & Geriatrics, Faculty of Physical Therapy, Cairo University, Giza, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Donna","family":"Fitzsimons","sequence":"additional","affiliation":[{"name":"School of Nursing and Midwifery, Queen\u2019s University of Belfast, Belfast, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Judy","family":"Bradley","sequence":"additional","affiliation":[{"name":"Wellcome Trust-Wolfson NI Clinical Research Facility, Queen\u2019s University Belfast, Belfast, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Magda","family":"Sedhom","sequence":"additional","affiliation":[{"name":"Basic Science Department, Faculty of Physical Therapy, Cairo University, Giza, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hady","family":"Atef","sequence":"additional","affiliation":[{"name":"Department of Physical Therapy for Cardiovascular\/Respiratory Disorder & Geriatrics, Faculty of Physical Therapy, Cairo University, Giza, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,11,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2193","DOI":"10.1002\/ehf2.12875","article-title":"Prioritizing symptom management in the treatment of chronic heart failure","volume":"7","author":"Koshy","year":"2020","journal-title":"ESC Heart Fail."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"605","DOI":"10.1016\/j.jchf.2020.03.008","article-title":"Impaired Exercise Tolerance in Heart Failure With Preserved Ejection Fraction: Quantification of Multiorgan System Reserve Capacity","volume":"8","author":"Nayor","year":"2020","journal-title":"JACC Heart Fail."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"366","DOI":"10.1016\/j.hrtlng.2019.05.016","article-title":"Heart failure symptom clusters and quality of life","volume":"48","author":"Salyer","year":"2019","journal-title":"Heart Lung"},{"key":"ref_4","first-page":"CD003331","article-title":"Exercise-based cardiac rehabilitation for adults with heart failure (Review)","volume":"1","author":"Long","year":"2019","journal-title":"Cochrane Libr. 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