Effect of Liuzijue and Box Breathing on Inspiratory Capacity and Blood Pressure After Femoral Neck Fracture Immobilization

NCT07389291 | Completed

• 1 other identifier: 065/05/2025/ISRB/PGSR/SCPT
• Study Type: interventional
• Target: 40
• Locations: 1 country
• Sites: 1

Brief Summary

The purpose of this study is to understand how two simple breathing exercise techniques (Liuzijue and box breathing) affect inspiratory capacity and blood pressure in people who were immobilized after a femoral neck fracture. Older adults who sustain a femoral neck fracture are often required to remain immobile for several weeks. Prolonged immobilization can reduce lung capacity and may negatively affect blood pressure control, increasing the risk of breathing difficulties and other health problems. Breathing-based exercise techniques may help improve respiratory function and cardiovascular stability during recovery. This study retrospectively analyzed data from patients who had previously received either Liuzijue exercises or box breathing techniques as part of their rehabilitation program. The main questions this study aimed to answer were: Do Liuzijue and box breathing techniques improve inspiratory capacity after a period of immobilization? Do these techniques help in controlling systolic and diastolic blood pressure? Is one technique more effective than the other over a 4-week intervention period? Data were collected at three time points: before the intervention (baseline), at the second week, and at the end of the fourth week. The findings of this study may help healthcare professionals choose simple, safe, and cost-effective breathing interventions for patients recovering from femoral neck fractures.

Conditions

Femoral Neck Fractures; Breathing Exercises; Inspiratory Capacity; Blood Pressure

Keywords

Femoral Neck Fractures; Qi Gong; Good Health and Well-Being; Aged

Outcome Measures

Primary Outcomes (1)

• Change in Inspiratory Capacity (mL) measured using Volume-Oriented Incentive Spirometer

  Inspiratory capacity will be quantitatively measured in milliliters (mL) using a volume-oriented incentive spirometer. Participants will perform three maximal slow inspiratory efforts in an upright sitting position, and the highest recorded value will be used for analysis. Measurements will be collected using the same calibrated spirometer device for all participants to ensure consistency. Data will be recorded as continuous numerical values in milliliters and analyzed as within-group and between-group changes over time.

  Baseline (Pre-test), Week 2, Week 4

Secondary Outcomes (2)

• Change in Systolic Blood Pressure (mmHg) measured using Digital Sphygmomanometer

  Baseline (Pre-test), Week 2, Week 4

• Change in Diastolic Blood Pressure (mmHg) measured using Digital Sphygmomanometer

  Baseline (Pre-test), Week 2, Week 4

Study Arms (2)

Liuzijue Qi Gong Exercise Group

EXPERIMENTAL

Other: Liuzijue Qi Gong Exercise

Box Breathing Technique Group

ACTIVE COMPARATOR

Other: Box Breathing Technique

Interventions

Liuzijue Qi Gong Exercise OTHER

Liuzijue Qi Gong is a gentle breathing exercise from traditional Chinese medicine. It involves six specific vocal sounds ("Xu", "He", "Hu", "Si", "Chui", and "Xi"). The practice promotes deep, diaphragmatic breathing, improves lung function and supports relaxation. Participants performed Liuzijue Qi Gong exercises for 20 minutes, twice daily, 6 days per week, for 4 weeks following femoral neck fracture.

Also known as: Six Character Qi Gong

Liuzijue Qi Gong Exercise Group

Box Breathing Technique OTHER

Box Breathing is a controlled breathing exercise that involves four equal phases: inhale, hold, exhale, hold, typically performed for 4-6 seconds each. It helps regulate breathing, reduce stress, improve oxygenation, and enhance autonomic balance. Safely practiced by older adults or individuals with limited physical activity. Participants performed the Box Breathing technique for 20 minutes, twice daily, 6 days per week, for 4 weeks following femoral neck fracture.

Also known as: Four-Square Breathing

Box Breathing Technique Group

Eligibility Criteria

• Age: 65 Years - 85 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Older Adult (65+)

You may qualify if:

• Participants aged between 65-85 years
• Femoral neck fracture managed conservatively or surgically.
• Volume-oriented incentive spirometer level less than 1000ml
• Blood pressure between 130/85 mmHg and 150/95 mmHg, not on regular antihypertensive medications
• Minimum 2 weeks of immobilization following the fracture.
• Ability to understand instructions and follow simple exercise routines.
• Ability to provide informed consent.

You may not qualify if:

• Recent major surgery (other than the femoral fracture)
• Severe hearing or speech impairment
• Uncontrolled hypertension (BP \> 150/95 mmHg)
• Use of supplemental oxygen at rest
• Cognitive impairment
• History of cardiovascular events in the past 6 months
• History of recurrent syncope or dizziness
• Severe uncontrolled pain in the lower limb

Sponsors & Collaborators

• Saveetha University: lead

Study Sites (1)

Saveetha Medical College and Hospital (SMCH)

Chennai, Tamil Nadu, 602105, India

Location

Related Publications (5)

• Berggren M, Stenvall M, Englund U, Olofsson B, Gustafson Y. Co-morbidities, complications and causes of death among people with femoral neck fracture - a three-year follow-up study. BMC Geriatr. 2016 Jun 3;16:120. doi: 10.1186/s12877-016-0291-5.

  PMID: 27260196 BACKGROUND

• Zaliene L, Mockute A, Levickiene L. Breathing Interventions Improve Autonomic Function, Respiratory Efficiency and Stress in Dysfunctional Breathing: A Randomised Controlled Trial. Adv Respir Med. 2025 Dec 10;93(6):56. doi: 10.3390/arm93060056.

  PMID: 41439857 BACKGROUND

• Gouzoulis MJ, Vasudevan RS, Kaszuba SV, Seddio AE, Rubin LE, Grauer JN, Li M. Femoral Neck Fractures: Incidence, Reasons, and Risk Factors of Conversion From Hemiarthroplasty to Total Hip Arthroplasty. J Am Acad Orthop Surg Glob Res Rev. 2025 May 13;9(5):e24.00312. doi: 10.5435/JAAOSGlobal-D-24-00312. eCollection 2025 May 1.

  PMID: 40388471 BACKGROUND

• Feng F, Tuchman S, Denninger JW, Fricchione GL, Yeung A. Qigong for the Prevention, Treatment, and Rehabilitation of COVID-19 Infection in Older Adults. Am J Geriatr Psychiatry. 2020 Aug;28(8):812-819. doi: 10.1016/j.jagp.2020.05.012. Epub 2020 May 15.

  PMID: 32425471 BACKGROUND

• Xu S, Zhang D, He Q, Ma C, Ye S, Ge L, Zhang L, Liu W, Chen Z, Zhou L. Efficacy of Liuzijue Qigong in patients with chronic obstructive pulmonary disease: A systematic review and meta-analysis. Complement Ther Med. 2022 May;65:102809. doi: 10.1016/j.ctim.2022.102809. Epub 2022 Jan 29.

  PMID: 35093513 BACKGROUND

MeSH Terms

Conditions

Femoral Neck Fractures

Condition Hierarchy (Ancestors)

Hip Fractures; Femoral Fractures; Fractures, Bone; Wounds and Injuries; Hip Injuries; Leg Injuries

Study Officials

• Shenbaga Sundaram Subramanian

  Saveetha college of physiotherapy, Saveetha Institute of Medical and Technical Sciences [SIMATS].

  STUDY DIRECTOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: NON RANDOMIZED
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Principal Investigator

Study Record Dates

• First Submitted: January 15, 2026
• First Posted: February 5, 2026
• Study Start: September 1, 2025
• Primary Completion: September 27, 2025
• Study Completion: October 20, 2025
• Last Updated: February 5, 2026

Record last verified: 2026-01

Data Sharing

• IPD Sharing: Will not share

Locations

IN (1)