Diaphragmatic mobility influences dyspnea and exercise tolerance in patients with COPD.

The results of this study suggest that the reduction in diaphragm mobility in COPD patients is mainly due to air trapping and is not influenced by respiratory muscle strength or pulmonary hyperinflation.

Efeitos de programa de exercícios físicos direcionado ao aumento da mobilidade torácica em pacientes portadores de DPOC Introdução: A doença pulmonar obstrutiva crônica acarreta prejuízos na mecânica pulmonar e musculatura periférica. O treinamento físico dos pacientes com doença pulmonar obstrutiva crôni-ca é geralmente voltado à melhora das condições aeróbias e são raros os programas que abordam especificamente as alterações da caixa e musculatura torácicas.Objetivo: Avaliar o efeito de um programa de exercícios físicos direcionados ao aumento da mobilidade da caixa torácica sobre a capacidade funcional e psicossocial de pacientes portadores de doença pulmonar obstrutiva crônica moderada e grave. Método:Foram estudados 30 pacientes portadores de doença pulmonar obstrutiva crônica moderada e grave, divididos aleatoriamente em dois grupos: controle (GC) e tratado (GT). O GC foi submetido a um programa de educação e o GT foi submetido ao mesmo programa educacional e a um programa de exercícios físicos objetivando o aumento da mobilidade torácica. Os efeitos dos programas foram avaliados pela espirometria, mobilidade torácica, qualidade de vida, níveis de ansiedade e depressão e teste da caminhada de seis minutos (TC6).Resultados: Após dois meses de treinamento, somente o GT apresentou aumento na expansibilidade torácica (de 4,20 ± 0,58cm para 5,27 ± 0,58cm; p = 0,05) e no TC6 (de 469,73 ± 31,99m para 500,60 ± 27,38m; p = 0,01). Foi observado também que o GT apresentou melhora na qualidade de vida avaliada pelo St. George's Respiratory Questionnaire (SGRQ) e Chronic Respiratory Questionnaire (CRQ), bem como nos níveis de depressão após dois meses de tratamento. Não houve melhora da função pulmonar em nenhum dos dois grupos estudados. Conclusão:Exercícios direcionados ao aumento da mobilidade da caixa torácica melhoram a expansibilidade torácica, a qualidade de vida e a capacidade submáxima de exercício, bem como reduzem a dispnéia e os níveis de depressão nos pacientes portadores de doença pulmonar obstrutiva crônica. (J Pneumol 2003;29(5):287-94) 3. Doutor em Fisiologia.Endereço para correspondência -Elaine Paulin, Rua Marialva, 5.819, zona III -87502-100 -Umuarama, PR. Tel.: (44) 622-2652; e-mail: epaulin@unipar.brRecebido para publicação em 24/2/03. Aprovado, após revisão, em 11/6/03.

Background: There is currently no consensus on the indication and benefits of breathing exercises for the prevention of postoperative

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Objective: To evaluate diaphragmatic mobility in relation to lung function, respiratory muscle strength, dyspnea, and physical activity in daily life (PADL) in patients with COPD. Methods: We included 25 patients with COPD, classified according to the Global Initiative for Chronic Obstructive Lung Disease criteria, and 25 healthy individuals. For all of the participants, the following were evaluated: anthropometric variables, spirometric parameters, respiratory muscle strength, diaphragmatic mobility (by X-ray), PADL, and the perception of dyspnea. Results: In the COPD group, diaphragmatic mobility was found to correlate with lung function variables, inspiratory muscle strength, and the perception of dyspnea, whereas it did not correlate with expiratory muscle strength or PADL. Conclusions: In patients with COPD, diaphragmatic mobility seems to be associated with airway obstruction and lung hyperinflation, as well as with ventilatory capacity and the perception of dyspnea, although not with PADL.

| Background: Diaphragmatic evaluation is crucial in clinical practice, and no studies have reported the intraand interobserver reproducibilities of the radiographic method to evaluate diaphragmatic mobility. Objective: To analyze the reliability of radiographic measurement as a method for assessing the mobility of the left and right hemidiaphragms. Method: Forty-two patients, who were waiting for cholecystectomy surgery, were evaluated relative to the following parameters: physical examination, pulmonary function and radiographic evaluation. The measure of mobility of each hemidiaphragm was randomly determined by two physical therapists at two different times. The intra-and interobserver reproducibilities of the measurements were determined by the intraclass correlation coefficient (ICC[2,1]) and the 95% confidence interval (CI). The Bland-Altman plot was also used. The level of significance was 5%. Keywords: physical therapy; diaphragm; radiographic; reproducibility of the tests. HOW TO CITE THIS ARTICLESaltiel RV, Grams ST, Pedrini A, Paulin E. High reliability of measure of diaphragmatic mobility by radiographic method in healthy individuals. Braz J Phys Ther.

The aim of this study was to assess the reproducibility of the ultrasound (US) measurement of craniocaudal displacement of the left branch of the portal vein as an indirect method of measuring right hemidiaphragm mobility in healthy young adults. Forty-one healthy participants were selected, ranging from 20 to 30 years of age. The US tests were conducted and interpreted by two observers (A and B) on two separate occasions (Test 1 and Test 2). Intra-observer and interobserver reproducibility and repeatability of US measurements were determined by the intraclass correlation coefficient (ICC[2,1] ) using a 95% confidence interval (CI). Interobserver reproducibility assessment showed 'high correlation' for Test 1 and Test 2 (ICC[2,1]  = 0·83, 95% CI = 0·70-0·91, and ICC[2,1]  = 0·79, 95% CI = 0·61-0·89, respectively). Intra-observer reproducibility assessment showed 'moderate correlation' for observer A (ICC[2,1]  = 0·69, 95% CI = 0·45-0·84) and for observer B (ICC[2,1]  = 0·65, 95% CI = 0·39-0·81). Repeatability assessment showed 'high correlation' for all tests performed (ICC[2,1]  = 0·86, 0·80, 0·74, 0·79, P<0·001). In conclusion, US measurement of craniocaudal displacement of the left branch of the portal vein is a reproducible method of measuring right hemidiaphragm mobility in healthy young adults.