pp 1–8 | Cite as

The Effect of Breathing Retraining Using Metronome-Based Acoustic Feedback on Exercise Endurance in COPD: A Randomized Trial

  • Eileen G. CollinsEmail author
  • Christine Jelinek
  • Susan O’Connell
  • Jolene Butler
  • Domenic Reda
  • Franco Laghi



During exercise-training patients with chronic obstructive pulmonary disease (COPD) can entrain their breathing pattern to visual-feedback cues as to achieve a slower respiratory rate and prolong exhalation. The result is an improvement in exercise tolerance and a reduction in dynamic hyperinflation. Acoustic stimuli, including metronome-generated acoustic stimuli, can entrain human movements. Accordingly, we hypothesized that exercise duration and dynamic hyperinflation would be less after exercise-training plus breathing-retraining using a metronome-based acoustic-feedback system than after exercise-training alone.


Of 205 patients with COPD [FEV1 = 44 ± 16% predicted (± SD)] recruited, 119 were randomly assigned to exercise-training plus breathing-retraining using acoustic feedback (n = 58) or exercise-training alone (n = 61). Patients exercised on a treadmill thrice-weekly for 12 weeks. Before and at completion of training, patients underwent constant-load treadmill testing with inspiratory capacity measures every 2 min.


At completion of training, improvements in exercise duration in the breathing-retraining plus exercise-training and exercise-training alone groups were similar (p = 0.35). At isotime, inspiratory capacity increased (less exercise-induced dynamic hyperinflation) by 3% (p = 0.001) in the breathing-retraining plus exercise-training group and remained unchanged in the exercise-alone group. The between-group change in inspiratory capacity, however, was not significant (p = 0.08).


In patients with COPD, breathing-retraining using a metronome-based acoustic feedback did not result in improved exercise endurance or decreased dynamic hyperinflation when compared to exercise-training alone.

Trial registry:; No.: NCT NCT01009099; URL:


COPD Exercise Rehabilitation 



The study was supported by grants by the Department of Veterans Affairs, Veterans Health Administration, Office of Research & Development, Rehabilitation Research & Development, Department of Veterans Affairs, Merit Review Grant # F6955R.

Compliance with Ethical Standards

Conflict of interest

The authors have no conflicts of interest to report.

Supplementary material

408_2019_198_MOESM1_ESM.docx (130 kb)
Supplementary material 1 (DOCX 129 KB)


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Copyright information

© This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply  2019

Authors and Affiliations

  1. 1.Department of Biobehavioral Health Science, College of NursingUniversity of Illinois at ChicagoChicagoUSA
  2. 2.Physical Performance Laboratory, Research & Development ServiceEdward Hines Jr. Veterans Affairs HospitalHinesUSA
  3. 3.VA Cooperative Studies Program Coordinating CenterEdward Hines Jr, Veterans Affairs HospitalHinesUSA
  4. 4.School of Public HealthUniversity of Illinois at ChicagoChicagoUSA
  5. 5.Stritch School of MedicineLoyola UniversityMaywoodUSA
  6. 6.Pulmonary Medicine, Department of MedicineEdward Hines Jr, VA HospitalHinesUSA

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