Abstract
Subjects with chronic obstructive pulmonary disease (COPD) present breathing pattern and thoracoabdominal motion abnormalities that may contribute to exercise limitation. Twenty-two men with stable COPD (FEV1 = 42.6 +/- 13.5% predicted; age 68 +/- 8 years; mean +/- SD) on usual medication and with at least 5 years of diagnosis were evaluated at rest and during an incremental cycle exercise test (10 watts/2 min). Changes in respiratory frequency, tidal volume, rib cage and abdominal motion contribution to tidal volume and the phase angle that measures the asynchrony were analyzed by inductive respiratory plethysmography at rest and during three levels of exercise (30-50, 70-80, and 100% maximal work load). Repeated measures ANOVA followed by pre-planned contrasts and Bonferroni corrections were used for analyses. As expected, the greater the exercise intensity the higher the tidal volume and respiratory frequency. Abdominal motion contributed to the tidal volume increase (rest: 49.82 +/- 11.19% vs exercise: 64.15 +/- 9.7%, 63.41 +/- 10%, and 65.56 +/- 10.2%, respectively, P < 0.001) as well as the asynchrony [phase angle: 11.95 +/- 7.24 degrees at rest vs 22.2 +/- 15 degrees (P = 0.002), 22.6 +/- 9 degrees (P < 0.001), and 22.7 +/- 8 degrees (P < 0.001), respectively, at the three levels of exercise]. In conclusion, the increase in ventilation during exercise in COPD patients was associated with the major motion of the abdominal compartment and with an increase in the asynchrony independent of exercise intensity. It suggests that cycling exercise is an effective way of enhancing ventilation in COPD patients.
Highlights
Breathlessness and exercise intolerance are the most common symptoms in chronic obstructive pulmonary disease (COPD) and limit the patients’ participation in daily and social activities [1]
Pulmonary rehabilitation programs have been focusing on strategies to improve alveolar ventilation such as diaphragmatic breathing that seems to be related to modifications of breathing pattern [6]
We observed greater abdominal motion than rib cage motion in 22 COPD patients during exercise, independent of the exercise intensity. This thoracoabdominal motion behavior was related to increasing Vt, f and asynchrony
Summary
Breathlessness and exercise intolerance are the most common symptoms in chronic obstructive pulmonary disease (COPD) and limit the patients’ participation in daily and social activities [1]. Dynamic hyperinflation contributes greatly to the limitation of exercise tolerance in most patients with COPD [2]. Maximal ventilation during exercise is often limited by the mechanical constraints imposed by the lung pathophysiology [3]. The presence of the mechanical disadvantages contributes to abnormalities in thoracoabdominal motion at rest [4] and during exercise [5]. Pulmonary rehabilitation programs have been focusing on strategies to improve alveolar ventilation such as diaphragmatic breathing that seems to be related to modifications of breathing pattern [6]. Studies have reported a decrease in rib cage motion and an increase in abdominal motion during diaphragmatic breathing [7,8]
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