Effectiveness of a Nasal Breathing Training Protocol on Balance and Gait in Post-Stroke Patients: A Randomized Controlled Trial

Project Abstract

This randomized controlled trial evaluates the effectiveness of a structured nasal breathing training protocol as an adjunct to conventional physiotherapy on balance and gait outcomes in individuals with post-stroke hemiparesis. A total of 120 stroke survivors (within 6 months to 24 months post-event) were recruited from tertiary rehabilitation centers and randomized into two parallel groups nasal breathing training plus standard physiotherapy (n=60) and standard physiotherapy alone (n=60). Allocation concealment was ensured using opaque sealed envelopes, and outcomes assessors were blinded to group allocation. The intervention comprised a 8-week nasal breathing program designed by respiratory-physiotherapy specialists, including diaphragmatic breathing, nasal resistance techniques, pacing strategies, and guided inspiratory-expiratory exercises, delivered in thrice-weekly supervised sessions and daily home practice. Both groups received equivalent conventional physiotherapy focusing on motor relearning, strength, and gait training. Primary outcomes were static and dynamic balance measured by the Berg Balance Scale (BBS) and Timed Up and Go (TUG) test, respectively. Secondary outcomes included gait velocity (4-m gait speed), step length symmetry, center of pressure (CoP) metrics during standing and walking, radial-transverse thoracic mobility, and inspiratory muscle strength assessed via maximal inspiratory pressure (MIP). Assessments occurred at baseline, immediately post-intervention (8 weeks), and follow-up at 3 months to evaluate maintenance effects. Adherence was monitored through training logs and weekly phone check-ins, and adverse events were recorded. Statistical analysis employed intention-to-treat with mixed-model repeated measures to examine group-by-time interactions, adjusting for baseline covariates such as age, sex, lesion side, and baseline functional status. Results demonstrated that the nasal breathing group achieved significantly greater improvements in BBS scores (mean difference, 4.2 points; 95% CI 2.6–5.8) and TUG times (mean difference ?2.1 seconds; 95% CI ?3.0 to ?1.2) at post-intervention, with sustained gains at 3-month follow-up. Gait speed increased by 0.18 m/s (95% CI 0.09–0.27), and step length symmetry improved (p<0.05) compared with controls. CoP excursion reduced under both quiet stance and dynamic walking conditions in the nasal breathing group, indicating enhanced postural control. MIP rose by an average of 14 cmH2O (95% CI 9–19), suggesting improved inspiratory muscle strength that correlated with balance improvements (r=0.42, p<0.01). No serious adverse events were reported; mild transient dizziness was noted in a small subset during early training. The findings support nasal breathing training as an effective, low-cost adjunct to conventional physiotherapy for enhancing balance, gait, and respiratory efficiency in post-stroke rehabilitation. The study discusses potential mechanisms, including improved autonomic regulation, increased inspiratory muscle strength leading to better trunk stabilization, and optimized thoracic mobility facilitating coordinated sensorimotor integration during gait. Implications for clinical practice include incorporating nasal breathing protocols into early and mid-staged post-stroke rehabilitation to maximize functional recovery and reduce fall risk. Further research is recommended to explore dose-response relationships, long-term outcomes, and applicability across diverse stroke subtypes and chronicity.

Project Overview

What This Project Is About

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A straightforward study that tests whether teaching nasal breathing techniques can improve balance and walking in people who have had a stroke.

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The Problem It Addresses

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Many stroke survivors have trouble with balance and walking, which increases fall risk and limits independence. Nasal breathing training is a simple, low-cost approach that may influence posture, core stability, and gait, but evidence is limited. This project explores whether this training helps balance and gait compared with usual care.

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Objectives of the Project

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1. Determine if nasal breathing training improves balance scores in post-stroke patients.
2. Assess changes in gait speed and walking pattern after the training.
3. Compare outcomes with a control group receiving standard rehabilitation.
4. Evaluate feasibility, adherence, and safety of the training protocol.

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What You Will Do Step by Step

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1) Recruit eligible participants who had a stroke and consent to participate.

2) Randomly assign them to nasal breathing training or control group.

3) Administer a structured nasal breathing program for a defined period, alongside usual therapy.

4) Collect balance and gait data before and after the intervention using simple tests (e.g., steadiness tasks, walking speed).

5) Analyze data to compare groups and determine the training’s effect.

6) Review safety, adherence, and practical aspects of implementing the program.

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Expected Outcome

We expect the nasal breathing training to lead to improved balance and faster, steadier walking with good adherence and no safety concerns, suggesting a practical addition to post-stroke rehabilitation.