Open Journal of Respiratory Diseases
Vol.04 No.04(2014), Article ID:49905,7 pages

Breathing Television: A Breathing Controlled Multimedia Player for Reducing Breathing Rate

Matevz Leskovsek, Nika Pušenjak, Ana Lasic, Domen Ravnik

BREATHINGLABS.COM, Ljubljana, Slovenia


Copyright © 2014 by authors and Scientific Research Publishing Inc.

This work is licensed under the Creative Commons Attribution International License (CC BY).

Received 18 July 2014; revised 19 August 2014; accepted 18 September 2014


We have designed a breathing paced television; a television that plays content in sync with users’ activity of exhaling through pursed lips, to achieve better motivation and compliance of such exercises. Described system has been tested with control group who have watched the same video. Breathing rate reduction was significantly higher in active group (54.48% ± 8.34%) than in control group (6.84% ± 17.21%), however, the proposed method of watching television is obviously not as trivial as watching television per se.


Breathing Television, Breathing Rate Reduction, Pursed Lip Breathing, Pulmonary Rehabilitation

1. Introduction

Pursed lip breathing is a well-known technique in pulmonary rehabilitation, which reduces breathing rate and makes breathing more efficient [1] - [4] . Television has emerged into an efficient multimedia distribution platform, yet it is shown to disturb breathing and consequently increasing their breathing rate [5] - [9] . Increased breathing rate is often correlated with progression of various diseases [10] [11] and can be observed especially in anxiety and panic attacks [12] - [14] . In both western and eastern medical practice, reducing breathing rate has proven to be an efficient health improving method [15] -[18] . Breathing rate reduction is most often achieved by exhalation through pursed lips, commonly referred to pursed lip breathing (PLB). Exhalation through pursed lips creates resistance during exhalation which prolongs exhalation and allows more air to come out of the body [19] - [24] . PLB exercises are mainly delivered at care-giving levels such as nursing, post-operative care and respiratory physiotherapy care. In clinical environment such exercises are provided through the respiratory therapist or in written instructions as well (Figure 1).

Figure 1. Pursed lip breathing instructions as provided by Cleveland Clinic Foundation.

Our goal is to design a breathing paced television in a way to most efficiently reduce users’ breathing rate and also allow users to control television content. It will help to motivate patients to perform breathing exercises and bring a new point of interaction in entertainment, gaming and education applications as well.

2. Materials and Methods

To detect exhalation through pursed lips, a microphone equipped headset was used [25] -[27] . Breathing controlled television was designed using Adobe Flash and YouTube API with the following algorithm (Figure 2).

This algorithm was implemented using the following Actionscript code:

//initiate microphone var microphone: Microphone = Microphone.getMicrophone(); microphone.setSilenceLevel(30, 5); microphone.setLoopBack(true);

//sound transform, set volume to 0 var myTransform:SoundTransform = new SoundTransform(0); microphone.soundTransform = myTransform;

//add listener microphone.addEventListener(ActivityEvent.ACTIVITY, activityHandler); ------------------>exhalation detector

//read mic activity function activityHandler(event:ActivityEvent):void { //begining of exhale if(event.activating){ -------------------------------------------->exhalation start detected if(player != null){ player.playVideo(); ----------------------------> PLAY } } //end of exhale else{ ------------------------------------------>exhalation end detected if(player != null){ player.pauseVideo(); -------------------------------------->PAUSE } } }

Figure 2. Breathing television, algorithm realized with YouTube API and Actionscript 3.0.

When exhalation through pursed lips is detected, a video playback begins. It stops as soon as exhalation is not detected anymore.

Clinical trial was approved by Medical Ethics Committee of Slovenia on February 12th 2013. There were 51 healthy adults involved in a trial, who were randomly arranged into two groups. An image (Figure 3) was shown to all volunteers to apply the headset correctly.

First group (active group, 26 subjects) were watching a YouTube video (Psy: Gangnam style, length 4:13) which started and paused according to their activity of exhaling through pursed lips as described above. The second group (control group, 25 subjects) were watching the same YouTube video which was playing even though their breathing was incorrect. Breathing rate of both groups was acquired by a sensor measuring expansion of abdomen. After that a value of breaths-per-minute (BPM) was calculated with the Mindmedia Nexus 10 computer software. Breathing rate before and after watching a video was measured in both groups.

3. Results

Breathing rate reduction was calculated as a normalised difference between breathing rate in the beginning and at the end of the video, results are shown in Table 1.

To compare breathing rate reduction between groups, we have calculated a mean value, standard deviation and variance of breathing rate reduction in percentages for each group (Figure 4).

To test significant difference between groups, we have observed how breathing rate reduction is normally distributed, see Figure 5.

To see if the normal distribution is in place, we have used Levene’s test for variance and t-test to observe significance of difference between groups.

Because significance of t-test is lower than 0.05, the difference between active and control groups is statistically significant.

4. Conclusion

Breathing rate reduction was significantly higher in active group (54.48% ± 8.34%) than in control group (6.84% ± 17.21%). Although the proposed method of watching television content is obviously not as ordinary as watching television by itself.

Table 1. Breathing rate reduction.

Figure 3. Image shown to volunteers to apply the headset correctly.

Figure 4. Standard deviation and variance for active (A) and control (C) group.

Figure 5. Distribution of breathing rate reduction.

5. Discussion

Breathing rate reduction in active group is enormously bigger then in control group. It is important to know that the exhalation through pursed lips can lasts a lot longer than exhalation through nose (it reduces breathing rate enormously).

Because video in active group was controlled by user’s breathing, it lasted approximately 30% longer than in control group where it was played continuously. Consequently intervention in active group lasted longer which may have contributed to breathing rate reduction.

Breathing controlled television is efficient in reducing breathing rate, however it requires continuous activation of a video. Because playing is executed with user’s exhalation, the system is not as comfortable as normal television.

The video (Psy: Gangnam style) was chosen due to its popularity, which decreases cognitive effort of a video. Therefore it may have resulted in surprisingly efficient BRR in control group as can be observed in our data. We suppose that improvement of BRR would be even better in an experiment, if volunteers were watching a video that requires more cognitive effort.

Declaration of Interest

Matevz Leskovsek, PhD, is a partner at BREATHINGLABS.COM, a company that produces human computer interfaces for breathing exercises, breathing games, and breathing entertainment. Other authors declare no competing interests.


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