Author(s):
Vengata Subramani Manoharan, Ramani Subramaniam, Kotteswaran K, Santibuana Abd Rahman
Email(s):
vsmanoharan@unikl.edu.my
DOI:
10.52711/0974-360X.2025.00459 
Address:
Vengata Subramani Manoharan1,3, Ramani Subramaniam2, Kotteswaran K3, Santibuana Abd Rahman4
1Physiotherapy Department, Faculty of Pharmacy and Health Sciences, Universiti Kuala Lumpur Royal College of Medicine Perak, Ipoh, Malaysia.
2Department of Radiology, Faculty of Medicine, Universiti Kuala Lumpur Royal College of Medicine Perak, Ipoh, Malaysia.
3Department of Physiotherapy, Saveetha College of Physiotherapy, Saveetha Institute of Medical and Technical Sciences (SIMATS), Thandalam, IND.
4Faculty of Pharmacy and Health Sciences, Universiti Kuala Lumpur Royal College of Medicine Perak, Ipoh, Malaysia.
*Corresponding Author
Published In:
Volume - 18,
Issue - 7,
Year - 2025
ABSTRACT:
Background: High body mass index (BMI) is linked to impaired respiratory functions due to increased abdominal pressure and fat distribution affecting diaphragm efficiency. However, there are limited research on how these exercises specifically impact diaphragm thickness and contraction velocity in people with high BMI. This study aimed to evaluate the impact of a diaphragmatic muscle strengthening exercise program on diaphragm thickness and contraction velocity in individuals with high BMI. Methods: In a quasi-experimental design, 100 participants with high BMI (25-30) were randomly assigned to an experimental group (n=50) or a control group (n=50). The experimental group engaged in a 12-week diaphragmatic strengthening program including incentive spirometry and resisted exercises using sandbag, while the control group received only incentive spirometry training. Diaphragm thickness and contraction velocity were assessed by B-mode and M-mode ultrasound, respectively, at baseline and after 12 weeks. Results: The experimental group showed a significant increase in diaphragm thickness during inspiration (p<0.05) and a trend towards improvement during expiration. As well as the experimental group exhibited a significant increase in diaphragm contraction velocity (p<0.05). In contrast, the control group did not show significant changes in either thickness or velocity. Conclusion: The diaphragmatic strengthening program effectively improved both diaphragm thickness and contraction velocity in individuals with high BMI. These findings support the implementation of targeted exercise interventions to improve the diaphragm function in this population.
Cite this article:
Vengata Subramani Manoharan, Ramani Subramaniam, Kotteswaran K, Santibuana Abd Rahman. Effect of Diaphragmatic Strengthening on Muscle Thickness and Velocity of Diaphram Excursion in High Body Mass Index Individuals. Research Journal of Pharmacy and Technology. 2025;18(7):3191-5. doi: 10.52711/0974-360X.2025.00459
Cite(Electronic):
Vengata Subramani Manoharan, Ramani Subramaniam, Kotteswaran K, Santibuana Abd Rahman. Effect of Diaphragmatic Strengthening on Muscle Thickness and Velocity of Diaphram Excursion in High Body Mass Index Individuals. Research Journal of Pharmacy and Technology. 2025;18(7):3191-5. doi: 10.52711/0974-360X.2025.00459 Available on: https://rjptonline.org/AbstractView.aspx?PID=2025-18-7-39
REFERENCES:
1. Patel N, Chong K, Baydur A. Methods and applications in respiratory physiology: respiratory mechanics, drive and muscle function in neuromuscular and chest wall disorders. Frontiers in Physiology. 2022; Jun 14; 13: 838414. doi.org/10.3389/fphys.2022.838414
2. Yun R, Bai Y, Lu Y, Wu X, Lee SD. How Breathing Exercises Influence on Respiratory Muscles and Quality of Life among Patients with COPD? A Systematic Review and Meta‐Analysis. Canadian Respiratory Journal. 2021; 2021(1): 1904231. doi.org/10.1155/2021/1904231
3. Dixon AE, Peters U. The effect of obesity on lung function. Expert Review of Respiratory Medicine. 2018; Sep 2; 12(9): 755-67. doi.org/10.1080/17476348.2018.1506331
4. Hsu YE, Chen SC, Geng JH, Wu DW, Wu PY, Huang JC. Obesity-related indices are associated with longitudinal changes in lung function: a large taiwanese population follow-up study. Nutrients. 2021; Nov 12; 13(11): 4055. doi.org/10.3390/nu13114055
5. Anderson MR, Shashaty MG. Impact of obesity in critical illness. Chest. 2021; Dec 1; 160(6): 2135-45. doi.org/10.1016/j.chest.2021.08.001
6. Parameswaran K, Todd DC, Soth M. Altered respiratory physiology in obesity. Canadian Respiratory Journal. 2006; 13(4): 203-10. doi.org/10.1155/2006/834786
7. Svartengren M, Cai GH, Malinovschi A, Theorell-Haglöw J, Janson C, Elmståhl S, Lind L, Lampa E, Lindberg E. The impact of body mass index, central obesity and physical activity on lung function: results of the EpiHealth study. ERJ Open Research. 2020; Oct 1; 6(4). doi.org/10.1183/23120541.00214-2020
8. Dixon AE, Peters U. The effect of obesity on lung function. Expert Review of Respiratory Medicine. 2018; Sep 2; 12(9): 755-67. doi.org/10.1080/17476348.2018.1506331
9. Cesanelli L, Cesanelli F, Degens H, Satkunskiene D. Obesity-related reduced spirometry and altered breathing pattern are associated with mechanical disadvantage of the diaphragm. Respiratory Physiology and Neurobiology. 2024; Jul 1; 325: 104267. doi.org/10.1016/j.resp.2024.104267
10. Langer D, Ciavaglia C, Faisal A, Webb KA, Neder JA, Gosselink R, Dacha S, Topalovic M, Ivanova A, O’Donnell DE. Inspiratory muscle training reduces diaphragm activation and dyspnea during exercise in COPD. Journal of Applied Physiology. 2018; Aug 1; 125(2): 381-92. doi.org/10.1152/japplphysiol.01078.2017
11. Enright SJ, Unnithan VB, Heward C, Withnall L, Davies DH. Effect of high-intensity inspiratory muscle training on lung volumes, diaphragm thickness, and exercise capacity in subjects who are healthy. Physical Therapy. 2006; Mar 1; 86(3): 345-54. doi.org/10.1093/ptj/86.3.345
12. Souza H, Rocha T, Pessoa M, Rattes C, Brandão D, Fregonezi G, Campos S, Aliverti A, Dornelas A. Effects of inspiratory muscle training in elderly women on respiratory muscle strength, diaphragm thickness and mobility. Journals of Gerontology Series A: Biomedical Sciences and Medical Sciences. 2014; Dec 1; 69(12): 1545-53. doi.org/10.1093/gerona/glu182
13. Tenório LH, Santos AC, Câmara Neto JB, Amaral FJ, Passos VM, Lima AM, Brasileiro-Santos MD. The influence of inspiratory muscle training on diaphragmatic mobility, pulmonary function and maximum respiratory pressures in morbidly obese individuals: a pilot study. Disability and Rehabilitation. 2013; Oct 1; 35(22): 1915-20. doi.org/10.3109/09638288.2013.769635
14. Inbar OM, Weiner PA, Azgad YA, Rotstein AR, Weinstein YI. Specific inspiratory muscle training in well-trained endurance athletes. Medicine and science in sports and exercise. 2000; Jul 1; 32(7): 1233-7. doi.org/10.1097/00005768-200007000-00008
15. Boussuges A, Finance J, Chaumet G, Brégeon F. Diaphragmatic motion recorded by M-mode ultrasonography: limits of normality. ERJ Open Research. 2021; Jan 1; 7(1). doi.org/10.1183/23120541.00714-2020
16. Santana PV, Cardenas LZ, Albuquerque AL, Carvalho CR, Caruso P. Diaphragmatic ultrasound: a review of its methodological aspects and clinical uses. Jornal Brasileiro de Pneumologia. 2020; Nov 20; 46:e20200064. doi.org/10.36416/1806-3756/e20200064
17. Güneş S, Genç A, KURTAIŞ Y, Çiftçi F, Hayme S, Kaya A. Effects of pulmonary rehabilitation on diaphragm thickness and contractility in patients with chronic obstructive pulmonary disease. Turkish Journal of Medical Sciences. 2022; 52(1): 89-96. doi.org/10.3906/sag-2105-345
18. Lin TK, Chen MY, Cheng HH, Chow J, Chen CM, Chou W. Effectiveness of abdominal sandbag training in enhancing diaphragm muscle function and exercise tolerance in patients with chronic respiratory failure. Journal of the Formosan Medical Association. 2024; 123(10): 1087–1092. doi:10.1016/j.jfma.2024.01.021
19. Hala M, Hadeer SM, Tarek FA, Fatma AM. Efficacy of incentive spirometer training on diaphragmatic excursion and quality of life in hemodialysis patients. The Medical Journal of Cairo University. 2018; Dec 1; 86(December): 3997-4002. doi.org/10.21608/mjcu.2018.62195
20. Kodric M, Trevisan R, Torregiani C, Cifaldi R, Longo C, Cantarutti F, Confalonieri M. Inspiratory muscle training for diaphragm dysfunction after cardiac surgery. The Journal of Thoracic and Cardiovascular Surgery. 2013; Mar 1; 145(3): 819-23. doi.org/10.1016/j.jtcvs.2012.07.087