Effect of Core Exercises with Diaphragmatic Breathing on Peak Expiratory Flow Rate and Abdominal strength in Recreational Swimmers:A Randomized Control Trial

BRIEF RESUME OF INTENDED WORK

INTRODUCTION

Swimming requires efficient breath control and core stability for optimal performance.[3]

Increased work of respiratory muscles can lead to their fatigue and a sense of dyspnoea, which, in turn, can impair the ability to perform physical exercise.[5]

Respiratory muscle fatigue is defined as a loss in the capacity for developing force and/or velocity resulting from muscle activity under load, which reverses by rest.[5]

Many recreational swimmers experience limited breath control  and respiratory muscle fatigue leading to fatigue and inefficient strokes.

Diaphragmatic breathing strengthens respiratory muscles, while core exercises enhance stability and propulsion. [1]

De Palo et al. found that the diaphragm is actively recruited in many resistance training exercises ,including sit-ups [3]

Hence, Correct breathing (especially as it involves the respiratory muscles) is vital to abdominal training because respiratory muscles are directly involved during common core stability exercises. [3]

This study investigates how integrating these two components improves lung function, breath control, and core strength in swimmers.

Diaphragmatic Breathing will help in [1]

Increased lung capacity (FVC,FEV1) which will lead to more amount of oxygen intake per breath

Better breath control which will lead to better endurance and reduced amount of respiratory fatigue

Increase in strength of diaphragm and intercostal muscles which will lead to efficient expiration

Abdominal Strength Training will help in [1]

Stronger core stability which will lead to better body alignment and better propulsion under water

Increased stroke efficiency which will lead to better co-ordinated movements under water

Ultimately with both training protocols the swimmer will have increased breath synchronization , better core strength for propulsion under water and increased oxygen sufficiency for longer swimming distances with less respiratory fatigue

NEED FOR THE STUDY

Recreational swimmers rely on efficient breathing and core stability to enhance their performance and reduce fatigue. The core muscles play a crucial role in stabilizing the body during swimming, while proper breathing mechanics influence oxygen intake and overall endurance. Despite the known benefits of core training and diaphragmatic breathing, limited research exists on their combined effects on respiratory function and abdominal muscle strength in swimmers.

In  a study performed in 2015 in Italy , there was a positive effect of different core exercises on respiratory parameters and abdominal strength in healthy individuals. In this study the subjects did not belong to a specific population.[1]

In a recent study performed in 2022 in Poland , the aim of the study was to find out whether a six-week moderate-intensity swimming intervention with added respiratory dead space (ARDS) resulted in any differences in respiratory muscle variables and pulmonary function in recreational swimmers . Wherein there was no significant changes observed in inspiratory or expiratory muscle strength in the groups. [5]

A recent study which was performed in 2022 in Gujarat wherein there was a positive effect of core exercises with diaphragmatic breathing on pulmonary function and abdominal endurance in young healthy females. [2]

Recreational swimmers often face breath control issues, respiratory muscle fatigue, and poor core stability, which would affect the performance while swimming and would lead fatigue [5]

Breathing in water is different from land-based activities which requires controlled inspiration & expiration for efficiency.

The present study will help recreational swimmers optimize the amount of oxygen intake and to improve lung capacity for better swimming efficiency with the help of SWOLF Index.

The study will provide evidence-based training strategies for improving swimming performance, endurance, and overall fitness and to examine how integrating these two components optimizes swimming performance in recreational swimmers.

AIMS OF THE STUDY

To determine and compare the effect of Core Exercise with Diaphragmatic Breathing on Peak Expiratory Flow Rate and Abdominal Strength in Recreational Swimmers

OBJECTIVES OF THE STUDY

To determine the Effect of Core exercises with Diaphragmatic breathing on Peak Expiratory Flow Rate and Abdominal strength in Recreational Swimmers

To compare the Effect of Core Exercises with Diaphragmatic Breathing on Peak Expiratory Flow Rate & Abdominal Strength in Recreational Swimmers

HYPOTHESIS

NULL HYPOTHESIS-

There will be no difference in

N0 (1) – Effect of Core exercises with Diaphragmatic Breathing on Peak Expiratory Flow Rate in Recreational Swimmers

(2) – Effect of Core exercises with Diaphragmatic Breathing on Abdominal Strength in Recreational Swimmers

ALTERNATIVE HYPOTHESIS –

There will be a difference in

A0 (1) - Effect of Core Exercises with Diaphragmatic Breathing on Peak Expiratory Flow Rate in Recreational Swimmers

(2) – Effect of Core Exercises with Diaphragmatic Breathing on Abdominal Strength in Recreational Swimmers

REVIEW OF LITERATURE:

The study performed by Cavaggioni et al. in 2015 examines the effects of different core exercises on respiratory parameters and abdominal strength. The researchers compared various core exercises to assess their impact on maximal voluntary ventilation (MVV) and abdominal muscle strength. Results showed that specific core exercises significantly improved both MVV and abdominal strength, suggesting a link between core stability and respiratory function. The study highlights the importance of core training for enhancing both respiratory efficiency and muscular performance..[1]

Ansari and Mishra in 2022, studied the effects of core exercises combined with diaphragmatic breathing on pulmonary function and abdominal endurance in young healthy females. Their findings showed significant improvements in lung function parameters, such as forced vital capacity (FVC) and forced expiratory volume (FEV1), along with enhanced abdominal endurance. The study suggests that incorporating diaphragmatic breathing into core training can optimize respiratory efficiency and core muscle performance. [2]

Sable et al. conducted a study in 2012 in which a comparative study to evaluate lung function differences between swimmers and runners. The results showed that swimmers had significantly better pulmonary function parameters, including forced vital capacity (FVC), forced expiratory volume in one second (FEV1), and peak expiratory flow rate (PEFR), compared to runners. The study attributes these differences to the respiratory adaptations required for swimming, which involve controlled breathing and resistance from water. [3]

Madou et al. performed a study in 2021 in which they investigated the effectiveness of the SWOLF index in assessing and predicting swimming performance. SWOLF, a combination of stroke count and time, is analyzed as a measure of efficiency across different skill levels. The study examines its correlation with performance metrics and evaluates its reliability in training and competition. Findings suggest that while SWOLF is useful for monitoring technique, it should be interpreted alongside other physiological and biomechanical factors for a comprehensive assessment. [9]

Kyriakidou et al. investigated the effects of a three-month training break on swimming performance in athletes with intellectual disabilities. The study found that the break led to declines in swimming speed, endurance, and overall performance, highlighting the importance of consistent training. The findings emphasize the need for structured training programs to maintain performance levels in these athletes.[1]

|METHODOLOGY

7.1 Method of Collection of Data:

SOURCE OF DATA – Recreational Swimming Centre in and around Belagavi City

STUDY DESIGN –Experimental Study

STUDY TYPE – Randomized Control Trial

DURATION OF STUDY – 1 year

STUDY POPULATION – Subjects of all genders who subjects of all genders who wants to perform recreational swimming (beginners) from 18-35 years of age.

SAMPLING DESIGN – Non-Probability Sampling

SAMPLING TYPE –Purposive Sampling

SAMPLE SIZE – 40 (20 in each group)

MATERIALS USED:

1.Informed Consent Process

2.Data Collection Sheets

3.Pen/Paper

TOOLS AND EQUIPMENTS:

1.     Peak Flow Meter (Breathe-O-Meter – Cipla) (r=0.97) [6]

2.     Exercise Mat

3.     Universal Goniometer (r=0.94) (13)

7.2. Inclusion Criteria:

Subjects of all genders who would be performing recreational swimming (beginners) from 18-35 years of age [5,7]

Must not have any cardiovascular disease, pulmonary diseases, or musculoskeletal injuries that could affect performance or safety during exercises.

Not been trained previously in structured diaphragmatic breathing techniques.

Willing to participate in the study.

Exclusion Criteria:

Subjects with a history of asthma, chronic obstructive pulmonary disease (COPD), or other chronic lung conditions

Subjects with recent abdominal surgery, hernia, or other significant abdominal injuries.

Pregnant females

Subjects who are cognitively impaired.

7**.3 OUTCOME MEASURES**:

q PEAK EXPIRATORY FLOW RATE (r=0.97) [6]

•        Peak expiratory flow (PEF) is a key indicator of pulmonary lung function tests.

•        It is measured with a peak flow meter, PEF provides an objective measure of airflow limitation and a maximal effort is required when using a peak flow meter to obtain valid results

Instructions for the subjects to perform the following process:

1.     Move the indicator to 0.

2.     Stand or sit up straight.

3.     Take in a breath as deep as possible.

4.     Place the meter in the mouth and close the lips around the mouthpiece, ensuring the tongue is not blocking or inside the opening.

5.     As soon as the lips are closed, blow out as hard and fast as possible, using the chest and abdominal muscles. This should take no more than 2 seconds.

6.     Write down the result.

7.     Repeat the steps above 2 more times.

q DOUBLE LEG-LOWERING TEST [11,12] (r=0.95)

•        The subject lies supine on a flat surface with their hands crossed over their chest.

•        The tester passively lifts both legs to a 90-degree hip flexion position.

•        The subject engages their abdominal muscles to posteriorly tilt the pelvis and flatten the lumbar spine against the surface.

•        The subject is instructed to slowly lower both legs towards the ground while maintaining the lumbar spine in contact with the surface.

•        The angle at which the lumbar spine begins to arch (detected by the tester’s hand under the lumbar spine) is recorded.

INTERPRETATION

Angle    Rating

90         Very poor, starting position

75         Poor

60        Below average

45          Average

30         Above average

15          Good

0             Excellent, legs horizontal

  q SWOLF INDEX  (r=0.73)[9,10]–

•        SWOLF, a quantitative measure, originates from the amalgamation of “swimming” and “golf”

•        Like golf, where a lower score signifies improved performance, SWOLF reflects performance in swimming by summing the total strokes taken to complete a specified distance (25 m) and the time required to swim this distance (SWOLF = T25 + SC25).

•        This index provides a measure of performance, offering a valuable means of comparing training sessions within a single individual, rather than between different individuals.

•        A lower SWOLF index indicates better swimming efficiency.

•        SWOLF INDEX – No. of arm strokes + No of time to cover a distance in seconds

•        For example – The score is of 45 in a 50m pool – 25 seconds at 20 strokes

PROCEDURE:

•        Study will be conducted after obtaining the ethical clearance from Institutional Ethical Committee.

•        Clinical Trial Registry India (CTRI) Number will be obtained.

•        The need of the study will be explained to the subjects in the language which is familiar to them.

•        Subjects will be screened for Inclusion and Exclusion Criteria.

•        Before starting the intervention the subjects will be briefed about the procedure and the intervention which is to be given

•        An informed consent will be obtained from the subject.

•        The subjects will be randomly allocated into Group A (Interventional Group) and Group B (Control Group) using envelope method

•        On the first day Baseline Evaluation will be done for Respiratory Measurement and Abdominal Strength before and after intervention.

•        Peak Expiratory Flow Rate will be assessed through Peak Flow Meter.

•        Abdominal Strength will be checked with the help of Double Leg-Lowering Test.

•        Swimming Efficiency will be checked with SWOLF Index.

•        The subjects in Group A will receive Diaphragmatic Breathing – 2-3 seconds during Inspiration and 8-10 seconds during Expiration with Abdominal Core Exercise of performing Crunches and Crunches with rotation – 15 repetitions with 2 sets

•        The subjects in Group B will receive only Abdominal Core Exercise – Crunches and Crunches with Rotation – 15 repetition with 2 sets

PROTOCOL:

• Group A –

Diaphragmatic Breathing – 2-3 seconds during Inspiration and 8-10 seconds during Expiration with Abdominal Core Exercise of performing Crunches and Crunches with Rotation – 15 repetitions with 2 sets

1. Crunch: The subject lies on his back with knees bent, feet on the floor, and hands resting on the chest. During inhalation, the shoulders are lifted off the ground; during exhalation, the subject returns to the starting position.

2. Crunch with rotation: The subject lies on his back with knees bent and feet on the floor. During exhalation, the trunk is lifted and rotated; during inhalation, the subject returns to the starting position.

4 times a week for 4 weeks for 15 minutes

• Group B –

Abdominal Core Exercise – Crunches and Crunches with Rotation – 15 repetition with 2 sets

3 times a week for 4 weeks for 15 minutes

SAMPLE SIZE ESTIMATION

Sample size determination

To determine sample size, technique of estimating sample size for Paired “t” test was used:

             Where,

Significance level (5%)

Effect size (0.70)

Power (80%)

Anticipated drop outs (10%)

Thus, the sample size for this study is determined as 18 + 2 = 20 (Each group).