Effects of Adding Respiratory Training to Osteopathic Manipulative Treatment on Exhaled Nitric Oxide Level and Cardiopulmonary Function in Patients With Pulmonary Arterial Hypertension

Limited research exists regarding nonpharmacologic management of pulmonary arterial hypertension (PAH), except for exercise training. The objective of this study was to investigate the effects of osteopathic manipulative treatment (OMT) alone and combined with respiratory training on fractional exhaled nitric oxide (FeNO), and cardiopulmonary function in patients with PAH. This single-blind, prospective, randomized controlled study included 54 patients with PAH who were randomly allocated to OMT, combined intervention, and control groups. The OMT group (n = 16) and combined intervention group (n = 16) received OMT and yoga respiratory training plus OMT, respectively, twice a week for 8 weeks. The control group (n = 16) received no intervention. All patients undertook an educational lecture. FeNO level, pulmonary function, 6-minute walk distance (6MWD), maximal inspiratory and expiratory pressures, and handgrip strength were assessed at baseline and 8 weeks. Combined intervention and OMT groups significantly improved all outcome measures after 8 weeks of treatment (p 0.01), except mean forced expiratory flow between 25% and 75% of forced vital capacity, which did not change in the OMT group (p 0.05). The control group showed significant deteriorations in 6MWD, inspiratory and peripheral muscle strength, and pulmonary function except peak expiratory flow at 8 weeks (p <0.05). The combined intervention group revealed significantly greater improvements of FeNO, 6MWD, respiratory and peripheral muscle strength, and pulmonary function except mean forced expiratory flow between 25% and 75% of forced vital capacity compared with the OMT group (p <0.05). All outcomes significantly improved in both intervention groups versus the control group (p <0.05). Our study demonstrated that adding respiratory training to OMT provided further benefit to FeNO level and cardiopulmonary function compared with OMT alone and that the OMT might be a useful and safe intervention for patients who cannot attend cardiac rehabilitation programs. (c) 2021 Elsevier Inc. All rights reserved. (Am J Cardiol 2022;162:184-190)

Automated summary

Limited research exists on nonpharmacologic management of pulmonary arterial hypertension (PAH), with exercise training being a common intervention. This study aimed to investigate the effects of osteopathic manipulative treatment (OMT) alone and in combination with respiratory training on patients with PAH. Results showed that combining respiratory training with OMT led to greater improvements in FeNO levels and cardiopulmonary function compared to OMT alone, suggesting OMT could be a beneficial and safe intervention for PAH patients who cannot attend cardiac rehabilitation programs.