The breathing trainer (Breathing+ package, Breathing Labs, Slovenia) was provided for this study. It consists of a game application that was downloaded to a laptop as well as a headset. Once the game application is started, the sensor in the headset recognizes the patient’s respiration, which initiates the game, depending on the respiratory pressure and the rhythm of the respiratory cycle. This game application includes 14 different games including blowing a balloon, flying a kite, an airplane, and a windmill, etc. Each game has a total of 10 sets and provides the inhalation period, the longest exhalation period, and their average value in real time. The patients’ game preferences were taken into consideration, and the patients were allowed to select a specific screen of their choice. To avoid falls, the games were played with the patients seated in an armchair (although not leaning on the back of the chair). In the event that patients felt dizzy or seemed to lose control, a break time was given until normal rhythm and control was regained. The research assistants provided the patients with the instructions, and encouraged the patient to perform the tests, and also demonstrated the game and monitored the patients from the beginning till the end of the game. For a more effective breathing exercise, patients were asked to perform longer exhalations, and the game scores were recorded. Visual feedback of the score motivated the patients to increase their training load. The total duration of the game-based breathing exercises was 25 minutes; breathing control exercise for relaxation was performed for 5 minutes at the beginning and end of this period.
With regard to pulmonary function, after completing the 5-week intervention program, the FVC was significantly improved from 2.50 L to 3.15 L in the experimental group (p=0.001) but was not significantly improved in the control group. The FEV1 was significantly improved from 1.90 L to 2.43 L in the experimental group (p<0.05) and from 1.75 L to 1.80 L in the control group (p<0.05). In comparing the 2 groups, the degrees of change in the FVC and the FEV1 were statistically greater in the experimental group than in the control group (p<0.05). The MVV was significantly improved from 51.36 L/min to 66.56 L/min in the experimental group (p<0.05), whereas the MVV was decreased from 53.71 L/min to 49.15 L/min in the control group (p<0.05). In comparing the 2 groups, the degree of change in the MVV was statistically greater in the experimental group than in the control group (p<0.05). After the intervention, the value of the FEV1/FVC within groups increased (77.79±12.26% from 77.08±15.96% in the experimental and 79.59±13.32% from 71.71±21.36% in the control groups). However, there was no significant difference in the value of the FEV1/FVC between the 2 groups.