This guide has been written to provide you with general respiratory treatment options, as well as use cases for personalized treatment options for specific patients. It also includes information on proper breathing, posture, and more to help motivate users to stick to the plan you've designed for them.

 

Guide about

1. Introduction and general instructions
2. Application of Breathing Dumbbell in respiratory diseases
3. Application of Breathing Dumbbell in heart disease
4. Application of Breathing Dumbbell in neuromuscular diseases
5. Application of Breathing Dumbbell before and after surgery
6. Application of Breathing Dumbbell during Healthy Aging
7. Maintenance of respiratory muscle strength

 

1. Introduction and general instructions

Indications/intended use

The Breathing Dumbbell is intended to be used (1) for inspiratory muscle training (IMT), and (2) as an expiratory resistance device to provide positive expiratory pressure (PEP) as an alternative to pursed-lip breathing and to assist with mucus clearance. The device is suitable for use in clinical or home settings with patients 5 years and older [1].

Description

The Breathing Dumbbell is a drug-free breathing device designed to be used as a lung capacity increase and respiratory muscle exercise (RMT). It combines deep breathing and other exercise techniques to promote proper respiratory support by overcoming the weight of breathing weights. Through "breathing dumbbells", the strength and endurance of the breathing muscles will be increased, and the ventilation volume of the lungs will be increased accordingly. This will help increase the body's ability to take up oxygen and emit carbon dioxide, improving lung function and overall health. “Breathing dumbbells” can also improve laryngeal function, improving speech quality, strength, and swallowing efficiency [2-4].

Patient Characteristics

Patients with respiratory dysfunction that affects daily life, including: dyspnea or exercise intolerance, airway secretions, and reduced respiratory support required for articulation and safe swallowing.

Target patient group[5]

- Respiratory system (chronic obstructive pulmonary disease, asthma, chronic lung disease)

- Heart (congestive heart failure, coronary artery disease, hypertension)

- Neuromuscular (Parkinson’s disease, multiple sclerosis, myasthenia gravis, Pompe disease)

- Preoperative and postoperative (major thoracic and abdominal surgery, neurosurgery)

- Healthy aging

Remark

• Respiratory training requires the cooperation and enthusiasm of the patient. In patients who have experienced an exacerbation or chest infection, the risk of excessive fatigue of the inspiratory muscles should be judged on a clinical basis. In this case, the intensity and frequency of IMT should be reduced.
• IMT has proven successful in pediatric applications and can be applied with appropriate clinical judgment [6-8]. Note: The breathing dumbbell is not a toy and small parts may pose a choking hazard to children.

Clinical evidence

More and more scientific and medical evidence supports the effectiveness of RMT, and its applicable range of diseases is gradually expanding. For clinical evidence, please see the references attached to this document.

Common patient questions

Potential adverse effects include brief dizziness at the beginning of training, mild fatigue, and finger fatigue.

Contraindications

During initial training, we recommend careful observation for signs of acute exacerbation or excessive fatigue.

Caution should be exercised before initiating treatment in the following conditions: active hemoptysis, untreated pneumothorax, recent esophageal surgery, acute upper airway stenosis (true vocal cord mass, vocal cord adduction paralysis, subglottic stenosis), recent oral surgery , facial or skull trauma/surgery, acute sinusitis, epistaxis, hemodynamic instability, tympanic membrane rupture, or acute middle ear pathology (otitis media, otitis interna).

Working principle:

The device uses a purely mechanical and very simple operating mode for inspiratory muscle training (IMT) and positive expiratory pressure (PEP) therapy. The treatment is done by blowing/inhaling into the mouthpiece attached to the device. The applied expiratory/inspiratory pressure causes the breathing weight to rise, which slides freely within the transparent chamber. Up to six breathing weights can be stacked together for different levels of treatment, supporting up to 20 levels. As more breathing weights are used, the expiratory/inspiratory pressure required to raise the breathing weight increases.

 

Instructions for use:

• PEP positive pressure therapy (exhalation training):

1) Blow into the device, applying the set exhalation pressure so that the breathing weight hovers within the volume chamber.

2) Continue to blow to keep the breathing weight hovering for the required or specified time (seconds).

3) Stop breathing and rest for the specified time (seconds).

Before the start

• If you or your patient have access to the Internet, we recommend watching our free, easy-to-follow videos.
• If you or your patient do not have access to the Internet, you can also read the instructions on the packaging.
• If the patient is on continuous oxygen, ensure that oxygen is continuously supplied during RMT. If PRN oxygen has been ordered, it should be used if the patient becomes short of breath while performing RMT exercises.
• Introduce the patient to Breathing Dumbbelland explain RMT, demonstrating using their own Breathing Dumbbell.
• Adjust the patient’s position to maximize diaphragmatic breathing.
• Start with the simplest setup, place a breathing weight.

  Universal protocol

• Instruct the patient to place their lips against the mouthpiece rather than their teeth as this is more comfortable.
• Instruct the patient to look at the breathing weight and let the breathing weight float in the main volume chamber. It is most helpful for the therapist to demonstrate using their own Breathing Dumbbell.
• The patient should take the mouthpiece out of the mouth slightly to facilitate normal swallowing and prevent saliva from accumulating in the breathing dumbbell.
• If the patient has difficulty breathing without using the nose, it may be helpful to clamp the nose with a nose clip during initial instruction.
• Monitor vital signs as needed, including oxygen saturation (using pulse oximeter) and acute hypoxemia.
  • If extreme dyspnea occurs during or after training, training should be suspended until medical clearance is obtained.
• Obtain data on the number of breaths and resistance levels that each group can tolerate.
  • Patients should be asked frequently for feedback, including:
    • How do you feel?
    • Feeling short of breath or dizzy?
  • You should also observe:
    • The time each inhalation/exhalation should be sustained.
    • Inspiratory resistance should cause outward movement of the stomach during all inhalations. If your stomach moves inwards, this may be a sign of fatigue. Patients should rest more between breaths or sets of breaths, or temporarily downgrade.
    • Expiratory resistance should not cause cheek puffiness. If the patient cannot eliminate this phenomenon, the patient may need to rest more between breaths or temporarily lower the resistance level.

• Note: You may experience brief dizziness at the beginning of training.
  • This is a normal response to the forced inhalation/exhalation action. This phenomenon lasts very short and has limited impact on itself. If this occurs, subjects can continue training after symptoms subside. For this reason, we recommend that patients sit comfortably in a chair while using Breathing Dumbbell.

 

Rehabilitation treatment using "Breathing Dumbbell" can reduce the symptoms of various respiratory diseases and improve exercise capacity, daily living activities, and quality of life [3,10].

Purpose of usage

• Strengthen the inspiratory muscles (diaphragm, external intercostal muscles, accessory neck muscles) and expiratory muscles (internal intercostal muscles, abdominal muscles)
• Promote diaphragmatic breathing
• Reduce shortness of breath
• Reduce overinflation
• Reduce the use of bronchodilators

Specific clinical benefits

• Increase maximum inspiratory and expiratory pressure (PImax, PEmax) [11]
• Reduce dyspnea (BORG scale)[12]
• Improve exercise tolerance (6MWT)[12]
• Reduce hyperinflation, improve inspiratory fraction and inspiratory capacity (IC, IF capacity (IC, IF) [12,13]
• Increase peak inspiratory and expiratory flows (PIF, PEF) [6,14]
• Increase blood oxygen saturation[15]
• Improve diaphragm function[2]
• Improve delivery and distribution of inhaled drugs[14]
• Reduce the frequency of exacerbations[16]
• Reduce hospitalization rate[10,16]

Other benefits

• Improve quality of life [12]
• Reduce hospitalization and healthcare needs [16]
• Reduce the risk of death [13]

 

 3. Application of Breathing Dumbbell in heart disease

The main symptoms of heart failure include dyspnea, fatigue, and exercise intolerance. Respiratory muscle weakness is a major cause of these symptoms [12,17].

Rehabilitation therapy using Breathing Dumbbells further supports return to activity by improving dyspnea and exercise intolerance and oxygen supply, as well as cardiac autonomy and blood flow to the extremities. RMT may further reduce the risk of cardiovascular disease by lowering blood pressure [12,18-20].

Purpose of usage

• Strengthen the inspiratory muscles (diaphragm, external intercostal muscles, accessory neck muscles) and expiratory muscles (internal intercostal muscles, abdominal muscles)
• Promote diaphragmatic breathing
• Reduce shortness of breath
• Improve blood flow in stationary and moving limbs
• Delay activation of metabolic reflex

Specific clinical benefits

• Increase maximum inspiratory and expiratory pressure (PImax, PEmax)[11]
• Reduce dyspnea (BORG scale)[12]
• Improve exercise tolerance (6MWT)[12]
• Reduce hyperinflation and increase inspiratory fraction and volume (IC, IF) [12,13]
• Peak inspiratory and expiratory flows (PIF, PEF) increase [6,14]
• Increase blood oxygen saturation[15]
• Improve cardiac autonomic and sympathetic nervous activity [12,18]
• Reduce systolic and diastolic blood pressure [20]

Other benefits

• Improve quality of life(QOL) [12]
• Reduce hospitalization and healthcare needs [16]
• Reduce the risk of death [13]

 

 4. Application of Breathing Dumbbell in neuromuscular diseases

Neuromuscular diseases, such as Parkinson's disease, myasthenia gravis, or muscular dystrophy, are often accompanied by peripheral and respiratory muscle weakness. Peripheral muscle weakness and respiratory muscle weakness may gradually worsen during the course of the disease. Depending on the disease, respiratory muscle weakness can lead to speech and swallowing difficulties, reduced speech intensity, and dyspnea [21,22].

Rehabilitation therapy using "breathing dumbbells" improves speech, swallowing, and cough function, reduces saliva penetration and aspiration, and strengthens respiratory muscles. Please note that people with muscular dystrophy should only use RMT under the guidance of a doctor to avoid overtraining.

Purpose of usage

• Strengthen the inspiratory muscles (diaphragm, external intercostal muscles, accessory neck muscles) and expiratory muscles (internal intercostal muscles, abdominal muscles)
• Improve movement of glossopharyngeal complex
• Improve airflow through the vocal cords
• Improve respiratory support and achieve safe swallowing function
• Improve protective cough and help clear the airway
• Promote diaphragmatic breathing
• Reduce shortness of breath
• Can slow down the progression of respiratory myopathy

Specific clinical benefits

• Increase maximum inspiratory and expiratory pressure (PImax, PEmax) [11]
• Reduce dyspnea (BORG scale)[12]
• Improve exercise tolerance (6MWT) and improve postural control[12,23]
• Reduce hyperinflation and improve inspiratory fraction and volume (IC, IF) [12,13]
• Peak inspiratory and expiratory flows (PIF, PEF) increase [6,14]
• Increase blood oxygen saturation[15]
• Improve laryngeal function and facilitate speaking and swallowing[21,24]
• Improve reflex cough and improve lung hygiene[24]
• Improve diaphragm function and support breathing and speech quality and strength[2]

Other benefits

• Improve quality of life(QOL) [12]
• Reduce hospitalization and healthcare needs [16]
• Reduce the risk of death [13]

 

5. Application of Breathing Dumbbell before and after surgery

Postoperative pulmonary complications (PPC), such as pneumonia and atelectasis, are a major cause of morbidity and mortality after major cardiac or abdominal surgery. Pulmonary complications can prolong hospital stays and increase medical costs.

Perioperative RMT using a "ventilator" reduces PPC risk, morbidity and mortality, and shortens hospital stay [25,26] .

Additionally, RMT reduces the risk of tracheal intubation and supports liberation from mechanical ventilation. RMT can shorten the offline time and improve the offline success rate [27-28].

Purpose of usage

• Strengthen the inspiratory muscles (diaphragm, external intercostal muscles, accessory neck muscles) and expiratory muscles (internal intercostal muscles, abdominal muscles)
• Promote diaphragmatic breathing
• Improve protective cough and help clear the airway
• Improve respiratory support and achieve safe swallowing function
• Improve movement of glossopharyngeal complex

Specific clinical benefits

• Increase maximum inspiratory and expiratory pressure (PImax, PEmax) [11]
• Improve diaphragm function and increase diaphragm thickness [2,30]
• Increase blood oxygen saturation[15]
• Reduce systolic and diastolic blood pressure[20]
• Improve laryngeal function and facilitate speaking and swallowing[21,24]
• Improve reflex cough and improve lung hygiene[24]

Specific benefits for hospitalized patients

• Shorten the time of mechanical ventilation[28]
• Improve the success rate of weaning from mechanical ventilation [27]
• Reduce the risk of postoperative pneumonia and atelectasis[25]
• Shorten hospital stay[16,26]
• Reduce in-hospital mortality [29]
• Reduce the risk of tracheal intubation [29]

Other benefits

• Improve quality of life(QOL) [12]
• Reduce hospitalization and healthcare needs [16]
• Reduce the risk of death [13]

 

6. Application of Breathing Dumbbell during Healthy Aging

During the normal aging process, respiratory muscle mass and function decline, reducing physical activity and functional independence, leading to sarcopenia and gait deterioration, thereby increasing the risk of falls.

Respiratory muscle weakness in the elderly can also lead to reduced lung elastic recoil, reduced airway clearance, and reduced response to hypercapnia and hypoxemia [30-32]

Respiratory muscle training (RMT) using "breathing dumbbells" strengthens the respiratory muscles, thereby increasing physical activity and exercise tolerance, and improving respiratory muscle function.

Purpose of usage

• Strengthen the inspiratory muscles (diaphragm, external intercostal muscles, accessory neck muscles) and expiratory muscles (internal intercostal muscles, abdominal muscles)
• Improve movement of glossopharyngeal complex
• Improve airflow through the vocal cords
• Improve respiratory support and achieve safe swallowing function
• Improve protective cough and assist in clearing the airway
• Promote diaphragmatic breathing
• Reduce shortness of breath
• Improve blood flow to resting and moving limbs

Specific clinical benefits

• Increase maximum inspiratory and expiratory pressure (PImax, PEmax) [11]
• Reduce dyspnea (BORG scale)[12]
• Improve exercise endurance (6MWT), improve postural control, and reduce back pain[23]
• Increase peak inspiratory and expiratory flows (PIF, PEF) [6,14]
• Reduce systolic and diastolic blood pressure[20]
• Improve the quantity and quality of sleep [20]
• Improve laryngeal function, promote speech and swallowing[21,24]
• Improve reflex cough and improve lung hygiene[24]
• Improve diaphragm function, support breathing and speech[2,30]

Other benefits

• Improve quality of life(QOL) [12]
• Reduce hospitalization and healthcare needs [16]
• Reduce the risk of death [13]

 

7. Maintenance of respiratory muscle strength

Like peripheral muscle strength, respiratory muscles also require exercise to maintain muscle strength. To maintain the results achieved during initial training, RMT should be incorporated into daily routine. Scientific evidence shows that respiratory parameters and exercise capacity continue to improve during at least the first year of RMT. However, there is also evidence that improvements in respiratory parameters and exercise capacity are lost after cessation of RMT [10].

• To achieve the best results of RMT, patients should strive to do 2 sets of 10 times, twice a day, 6 days a week. Twice a day, 6 days a week.
• After maintaining baseline training for approximately 1 week, increase resistance.
• As resistance is increased, the number of repetitions may initially decrease and then gradually increase over the course of a week.
• Choose breathing weight weights to achieve target reps for each workout without causing fatigue.
• Encourage the establishment of a fixed routine for using the respirator, such as after getting up and before going to bed, to facilitate better adherence to use.
• When possible, begin training the patient (or caregiver) as soon as possible to monitor resistance and duration (number of times) tolerance. Patients can develop these self-monitoring skills with guidance from their therapist, thereby increasing the likelihood of continuing RMT after a therapy session. Includes observing and feeling the correct technique outlined in "First Session" above, as well as monitoring diaphragmatic breathing. To avoid abandoning RMT, educate patients to find new (usually lower) settings in situations such as illness.
• Record the patient's progress, such as resistance level, number of times and groups, number of sessions, maximum articulation time, ventilatory response index, and dyspnea scale.
• If possible and useful, set goals for the patient, such as being able to walk up stairs without taking a break.
• If the patient frequently experiences shortness of breath or a "sense of panic," they can be instructed to breathe easily through the respirator on the lowest setting. Exhalation resistance mimics pursed-lip breathing, and slowing inhalation can be calming. Breathing can usually be brought under control in just a few moments.