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

Femoral neck fractures are common in the elderly population and are frequently associated with prolonged periods of immobilization. Extended immobilization can lead to reduced lung volumes, impaired inspiratory capacity and alterations in blood pressure regulation due to decreased physical activity and respiratory muscle disuse. These changes increase the risk of respiratory complications and cardiovascular instability during recovery.

Liuzijue is a traditional breathing-based exercise that combines slow, controlled breathing with specific vocalized exhalation patterns. It has been shown to improve respiratory muscle function, lung volumes and autonomic regulation. Box Breathing is a simple, structured breathing technique involving equal phases of inhalation, breath-holding, exhalation, and breath-holding and is known to promote relaxation and cardiovascular stability through autonomic nervous system modulation.

This retrospective study analyzed data from patients who had undergone a 4-week breathing-based intervention program following immobilization due to femoral neck fracture. Participants were divided into two groups based on the intervention they received: the Liuzijue exercise group and the Box Breathing technique group. Both interventions were administered for 20 minutes per session, twice daily, six days per week, over a period of four weeks as part of routine physiotherapy care.

Inspiratory capacity was measured using a volume-oriented incentive spirometer, while blood pressure parameters, including systolic and diastolic blood pressure, were recorded using a Digital sphygmomanometer. Outcome measures were documented at baseline (prior to intervention), at the end of the second week and at the completion of the fourth week.

The primary outcome of the study was the change in inspiratory capacity over the intervention period. Secondary outcomes included changes in systolic and diastolic blood pressure. Data were analyzed to evaluate within-group improvements over time and to compare the effectiveness of Liuzijue and Box Breathing techniques.

The findings of this study aim to provide evidence regarding the effectiveness of simple, non-invasive breathing-based interventions in improving respiratory function and blood pressure control in elderly individuals recovering from femoral neck fracture immobilization. The results may assist clinicians in selecting appropriate respiratory rehabilitation strategies for this population.

Inclusion criteria

• 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.

Exclusion criteria

• 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