Skip to main content

Resisted breathing exercise versus incentive spirometer training on vital capacity in postoperative radical cystectomy cases: a pilot randomized controlled trial



Radical cystectomy at times involves respiratory physical therapy aiming to reverse pulmonary dysfunction, thus avoiding postoperative pulmonary complications that increase hospital morbidity.


The aim of this study was to investigate the effects of resisted breathing exercise versus incentive spirometer (IS) training on vital capacity (VC) outcomes in postoperative radical cystectomy cases.

Patients and methods

Forty male and female patients between 40 and 80 years of age who had undergone radical cystectomy participated in this study. Patients were randomly assigned into two equal groups of 20 each; both groups received traditional physical approaches. In addition, group A (19 men and 1 woman) received IS training for 15 min daily for 6 weeks, and group B (16 men and 4 women) received resisted breathing exercise for 15 min daily, for 6 weeks. The primary outcome was VC, which was measured using an electronic spirometer.


This study showed a significant increase (P<0.05) in VC in both groups on comparing pretreatment and post-treatment values within each group. After 6 weeks of treatment, between-group statistical analysis showed equal improvements in VC (P=0.52). Nevertheless, the percentage of improvement in VC was 43.5% (2.46±0.64), higher than that in the resisted breathing exercise group at 23.9% (2.34±0.53).


IS produced better objective improvement in VC compared with the usage of resistive breathing exercise. However, both are considered as a gold therapeutic tool in the management of pulmonary complication after radical cystectomy.


  1. 1

    Messing EM, Catalona W. Urothelial tumors of the upper urinary tract. In: Walsh PC, Retik AB, Vaughan ED, Wein AJ, editors. Campbell’s urology. 8th ed. Philadelphia, PA: WB Saunders; 2002. 2765–2773.

    Google Scholar 

  2. 2

    Gaston R, Heidenreich A. Open versus laparoscopic radical cystectomy. Eur Urol Suppl 2006; 5:385–394.

    Article  Google Scholar 

  3. 3

    Ferguson MK. Preoperative assessment of pulmonary risk. Chest 1999; 115(Suppl):58S–63S.

    CAS  Article  Google Scholar 

  4. 4

    Brooks-Brunn JA. Postoperative atelectasis and pneumonia. Heart Lung 1995; 24:94–115.

    CAS  Article  Google Scholar 

  5. 5

    Renault JA, Costa-Val R, Rosseti MB, Houri NM. Comparison between deep breathing exercises and incentive spirometry after CABG surgery. Rev Bras Cir Cardiovasc 2009; 24:165–172.

    Article  Google Scholar 

  6. 6

    Ambrosino N, Gabbrielli L. Physiotherapy in the perioperative period. Best Pract Res Clin Anaesthesiol 2010; 24:283–289.

    Article  Google Scholar 

  7. 7

    Hall JC, Tarala RA, Tapper J, Hall JL. Prevention of respiratory complications after abdominal surgery: a randomized clinical trial. BMJ 1996; 312:148–152.

    CAS  Article  Google Scholar 

  8. 8

    Su MY, Chiang CD, Huang WL, Li SJ, King SL, Peng FK. A new device of incentive spirometry. Zhonghua Yi Xue Za Zhi (Taipei) 1991; 48:274–277.

    CAS  Google Scholar 

  9. 9

    Dean EW, Frownfelter DL. Clinical case study guide to accompany principles and practice of cardiopulmonary physical therapy. 3rd ed. St Louis, MO: Mosby Year Book Medical Pub; 1996. 749–760.

    Google Scholar 

  10. 10

    Hough A. Physiotherapy in respiratory care: an evidence-based approach to respiratory and cardiac management. 3rd ed. Cheltenham Nelson Thornes, Cengage Learning, 2001.

  11. 11

    Hsiao SF, Wu YT, Wu HD, Wang TG. Comparison of effectiveness of pressure threshold and targeted resistance devices for inspiratory muscle training in patients with chronic obstructive pulmonary disease. J Formos Med Assoc 2003; 102:240–245.

    PubMed  Google Scholar 

  12. 12

    Asmsen E. Exercise and regulation of ventilation. In: Circulation research. Philadelphia, PA: Lippincott Williams & Wilkins; 1967. 132–145.

    Google Scholar 

  13. 13

    Romer LM, Mcconnell AK. Specificity and reversibility of inspiratory muscle training. Med Sci Sports Exerc 2003; 35:237–244.

    Article  Google Scholar 

  14. 14

    Celli BR. Perioperative respiratory care of the patient undergoing upper abdominal surgery. Clin Chest Med 1993; 14:253–261.

    CAS  PubMed  Google Scholar 

  15. 15

    Pryor JA, Prasad AS. Physiotherapy for respiratory and cardiac problems: adults and pediatrics. XX: Elsevier Health Sciences 2008; 158–159.

  16. 16

    Hala ME, Shehab MA, Yousry AH. Exercise tolerance responses to prolonged pulmonary rehabilitation program after posterior approach surgical correction of idiopathic adolescent scoliosis. Bull Fac Ph. 2007; 12:11–21.

    Google Scholar 

  17. 17

    Agostini P, Calvert R, Subramanian H, Naidu B. Incentive spirometry effective following thoracic surgery? Interact Cardiovasc Thorac Surg 2008; 7:297–300.

    Article  Google Scholar 

  18. 18

    Weindler J, Kiefer RT. The efficacy of postoperative incentive spirometry is influenced by the device-specific imposed work of breathing. Chest 2001; 119:1858–1864.

    CAS  Article  Google Scholar 

  19. 19

    Welkowitz J, Ewen RB, Cohen J. Introductory statistics for the behavioral sciences. 3rd ed. San Diego, CA: Harcourt Brace Jo Vinovich; 1982.

    Google Scholar 

  20. 20

    Pipkin FB. Statistical analysis of the obtained data by descriptive and comparative analysis. Medical statistics made easy. London, UK: Churchill Livingstone; 1984.

    Google Scholar 

  21. 21

    Doyle RL. Assessing and modifying the risk of postoperative pulmonary complications. Chest 1999; 115:77–81.

    Article  Google Scholar 

  22. 22

    Celli BR, Rodriguez KS, Snider GL. A controlled trial of intermittent positive pressure breathing, incentive spirometry, and deep breathing exercises in preventing pulmonary complications after abdominal surgery 1–4. Am Rev Respir Dis 1984; 130:12–15.

    CAS  PubMed  Google Scholar 

  23. 23

    Overend TJ, Anderson CM, Lucy SD, Bhatia C, Jonsson BI, Timmermans C. The effect of incentive spirometry on postoperative pulmonary complications: a systematic review. Chest 2001; 120:971–978.

    CAS  Article  Google Scholar 

  24. 24

    Schweickert WD, Pohlman MC, Pohlman AS, Nigos C, Pawlik AJ, Esbrook CL, Schmidt GA. Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomized controlled trial. Lancet 2009; 373:1874–1882.

    Article  Google Scholar 

Download references

Author information



Corresponding author

Correspondence to Eman M. Othman PhD.

Additional information

This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work noncommercially, as long as the author is credited and the new creations are licensed under the identical terms.

Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Othman, E.M., Abaas, S.A. & Hassan, H.H. Resisted breathing exercise versus incentive spirometer training on vital capacity in postoperative radical cystectomy cases: a pilot randomized controlled trial. Bull Fac Phys Ther 21, 61–67 (2016).

Download citation


  • bladder cancer
  • breathing exercise
  • incentive spirometer
  • radical cystectomy