*4.5.8 Breathing exercises*

Advanced stage heart failure causes a decrease in cardiac flow and in the blood flow of peripheral and respiratory muscles. These changes can cause muscle dysfunction leading to fibre atrophy [basically type I] and weakness in peripheral and respiratory muscles. Therefore, muscle weakness related to frequent shortness of breath can cause fatigue, reduced functional capacity, and increased exercise intolerance in these patients. In this context, inspiratory muscle training [IMT] can be used as an assistive intervention to develop cardiopulmonary capacity in these individuals. Strengthening of the respiratory muscles provides more efficient airway clearance, inspiratory pressure, and maximal expiration, and prevents fatigue of the respiratory muscles [46].

Breathing exercises regulate cardiac parameters such as respiration, ejection fraction, aortic pressure, pulmonary artery pressure, and tissue oxygenation [47]. Slow breathing exercises are defined according to a controlled respiratory rate to reduce respiratory rate and increase respiratory breadth [tidal volume].

Deep breathing exercises are a form of exercise that focus on deep and slow respiration at targeted breaths per minute using the diaphragm.
