Effects of Various Angle on Respiration Function in Adults

Transcription

1 Indian Journal of Science and Technology, Vol 8(26), DOI: /ijst/2015/v8i26/80988, October 2015 ISSN (Print) : ISSN (Online) : Effects of Various Angle on Respiration Function in Adults Se-Eun Kwon, Dong-Yeop Lee, Ji-Heon Hong, Jae-Ho Yu and Jin-Seop Kim * Department of Physical therapy, Sun Moon University, Asan-Si, Chung-Nam, Korea; Skylove3373@sunmoon.ac.kr Abstract The purpose of this study is to find standing angle changes how effect on the pulmonary function. After pre-test, 13 healthy adult males and 12 females were recruited and had been agreed to participate in the study as the subjects (total 30). The participants were changed in their position (0 supine position, 45 lean sitting position, 90 standing position) and were measured up the pulmonary function. The results of three angles in FVC (Forced Vital Capacity), FEV₁ (Forced Expiratory Volume at one second), FEV₁/ FVC, show the significant difference. However, PEF (Peak Expiratory Flow) shows no significant difference. In conclusion, this study demonstrated that 90 standing position has more effect on respiration than 0 supine position and 45 lean sitting position. Keywords: Respiration, Tilt Table, Various Angle, Ventilation 1. Introduction Respiration means the occurrence of exhalation and inhalation in turns and the lung undertakes the role of exchange between air and blood 1. This happens through respiratory muscles and their neurophysiological control. The diaphragm is used as the main muscle for inhalation and rectus abdominis, internal oblique, external oblique and transversus abdominis muscle are used for exhalation 2. Such respiratory functions are correlated to posture change 3 5. Changes in posture can affect the resting length of respiratory muscles and according to Mori et al. 6, the vestibular system contributes to altering respiratory muscle activity during movement and changes in posture 6. In the Song et al. 5 study, there was a significant difference when comparing vital capacity of standing posture and head-bent posture 5 and another study showed that wrong posture can decrease lung capacity/vital capacity and weaken respiratory muscles by affecting thoracic wall expansion and ventilation of alveoli 7. It is asserted that sitting erect leads to significant increase of pulmonary functions and expansion of thoracic cage than other postures 8. Alternately, Shin et al. 9 asserted highest figure can be measured while sitting and lowest in supine position in a study into the effects of posture change during exercise on cardiac autonomic nervous activity 9. Since respiration is a compound function requiring musculoskeletal and nervous system cooperation 10, changes in pulmonary function due to posture are markedly observable in patients with neurological disorders accompanying weakened respiratory muscles 11. Respiration efficiency and change in respiratory functions reflect lung volume movement injury, asymmetry and muscle paralysis. In order to resolve this, thoracic expansion/ventilation, vital capacity and lung volume must be maintained 12. Skinner 13 stated assessment of patient s functional ability and degree of disorder diagnosis/progress/treatment should be accomplished through the accurate measurement of cardiopulmonary function 13. Patient s cardiopulmonary functions can differ according to what position they conduct treatment-purpose respiratory training in and cardiopulmonary function effects can differ according to what positions you train in for each disorder 14. Silveria 4 research stated that negative effects can occur if patients with respiratory disorders engage in wrong posture because respiratory functions can change according to posture 4. Current clinical research on posture change is conducted on various subjects. Supine position on tilting *Author for correspondence

2 Effects of Various Angle on Respiration Function in Adults bed, oblique position and upright position are especially being tested frequently. A large number of patients with neurological disorders who are mobility-impaired spend most of their time in bed and receive physical therapy in bed as well. Changes in cardiopulmonary function are important in finding out which angles are most convenient for in-bed treatments and daily activities for such patients 15. There is an increase in research into physical therapy and respiration as well as research into respiration according to posture change. However, research into respiration according to variant angle change is solely lacking. Thus this research aims to understand the influence of respiratory functions on standing angle by measuring breathing capacity after categorizing supine position (0 ), oblique position (45 ) and upright position (90 ) through simplification of posture shifts moderated most by current physical therapy. in Figure 1 and subsequently measured after shifting to a oblique position when the therapist switches the angle of the tilting bed to 45 in Figure 2. Lastly, the tilting bed is set to 90 and the subject is put in a erect position when breathing capacity measured in Figure 3. Measurement is always taken after 3 normal breaths. Forced exhalation capacity (exhaling fully and forcefully after inhaling as much as possible). Forced inhalation capacity (inhaling as deeply as possible). Forced Vital Capacity (FVC). Forced Expiratory Volume at one second (FEV₁). 2. Subjects and Methods 2.1 Subjets The research was conducted on 25 students in S University: 13 male and 12 female. Each student was randomly assigned to 0 supine position, 45 oblique position and 90 standing position. All subjects were voluntarily recruited after hearing explanations about the study and all subjects were without the history of pulmonary diseases or thoracic mutation / injury. The characteristics of research participants are noted in Table 1. This research was approved by the institutional bioethics committee in Sun Moon University s IRB (Institutional Review Board). 2.2 Method The subject lies down on the tilting bed with leg straps/ knee straps, but without chest straps in order to not disturb thoracic expansion and abdominal movements. They were allowed 3 trial practices to get used to the breathing patterns before conducting the experiment. The subject s breathing capacity is measured in supine position Figure 1. Supine position. Table 1. The general characteristics of the study subjects (n = 25) Division Value Age(years) ± 2.1 a Height(cm) ± 7.8 Weight(kg) ± Figure degree sitting position. 2 Vol 8 (26) October Indian Journal of Science and Technology

3 Se-Eun Kwon, Dong-Yeop Lee, Ji-Heon Hong, Jae-Ho Yu and Jin-Seop Kim also used to compare the difference between measured values of change in breathing capacity according to each angle. Bonferroni method was used for post-hoc to mark the changes between each variable. Statistical significance standard was set to α as Figure 3. Standing position. 3. Results There was a significant difference in FVC when comparing breathing capacity of three angles(p<.05). Significant differences were also found in FEV₁, FEV₁/FVC(p<.05), but not for PEF(p>.05) Table 2. Paired comparison showed lowest value for 0 and highest for 90 in the FVC graph. There is a significant difference(p<.05) in FVC between 0 45 and also between FVC in 0 graph and FVC in 90 graph(p<.05). However, there was no significant value between 90 and 45 degrees(p>.05) in Figure 5. There was a significant difference in FEV₁ between 0 FEV₁ and 90 FEV(p<.05), and also between 45 FEV₁ and 90 FEV₁(p<.05) (Figure 6). FEV1₁/FVC post-hoc Ratio of forced expiratory volume at one second against forced vital capacity (FEV₁/ FVC) and Peak Expiratory Flow (PEF) were measured. A cardiopulmonary function, highly correlated to airway resistance, was a variable for Forced Vital Capacity (FVC) and Forced Expiratory Volume at one second (FEV₁). Peak Respiratory Flow (PEF) can measure the maximum velocity of air at one moment during forced exhalation, in other words, how forcefully one can exhale. subjects were measured 3 times for each position and the mean value was used as the experimental value. Each position shift was administered after a 5 minute rest. Table 2. Comparison of respiratory function F FVC(l) 2.31±0.67 a 2.81±0.51 a 3.12±0.67 a * FEV1(l) 1.80± ± ± * FEV₁ / FVC (%) PEF(l/ sec) 74.39± ± ± * 2.01± ± ± * P<0.05; a standard deviation; FVC: Forced Vital Capacity; FEV1: Forced Expiratory Volume at one second; PEF: Peak Expiratory Flow. 2.3 Equipment Digital vital capacity assessment equipment (COSMED, Korea) was used and volume/flow of inhaled and exhaled air could be measured. The measurement was taken after the subject was provided sufficient explanation and demonstration for accurate assessment. 2.4 Analysis All measured values were statistically processed through SPSS 18.0 for Windows. Normality test was conducted through Shapiro-Wilk and the results passed the test. The mean and standard deviation for each measured value was calculated through One-way Repeated-ANOVA. It was Figure 4. Digital spirometry. Vol 8 (26) October Indian Journal of Science and Technology 3

4 Effects of Various Angle on Respiration Function in Adults Figure 7. Forced Expiratory Volume at one second / Forced Vital Capacity. Figure 5. Forced Vital Capacity. Figure 8. Peak Expiratory Flow. Figure 6. Forced Expiratory Volume at one second. comparison graph shows the significant difference between 0 and 90 (p<.05). Graph for 90 shows higher values than for 0 and 45 in Figure 7. PEF post-hoc comparison graph showed no significant difference among 0, 45 and 90 (p>.05) in Figure Discussion Results of this study showed, average FVC, FEV1, FEV₁/ FVC, PEF values for 90 is high and average value for 0 is smaller than for 45 and 90. Out of different studies, a study on stroke patients showed the significant difference in FVC and FEV₁ in 90 sitting position after conducting 4 weeks of respiratory exercise in the supine position and 90 sitting position 16. Pryor et al. 1 stated that the 45 oblique position is good for inhalation due to relaxed abdominal muscles 1. For a normal person, pulmonary functions are heightened in the upright position than a sitting position and effect is different according to posture 17. Another study into autonomic nervous system change at 0, 45 and 90 found big reduction at supine position showed lower breathing capacity than other positions in this study as well. This is considered as a result of the gravitational pressure of internal organs on the diaphragm in a supine position. Also Barret et al. 16 study was conducted on normal persons and when they were put upright in 90 after being in supine position, abdominal muscles increased each proprioceptive feedback from muscle spindle. Also it pulls abdominal muscles and stimulates the abdominal wall through stretch reflex and functional residual capacity increased through posture change 18. Average inhalation capacity was reported as being higher in a standing position than in supine position 19. Manshadi 4 Vol 8 (26) October Indian Journal of Science and Technology

5 Se-Eun Kwon, Dong-Yeop Lee, Ji-Heon Hong, Jae-Ho Yu and Jin-Seop Kim et al. 20 s recent study measured thickness of transversus abdominis in supine and standing position through ultrasound used for rehabilitation medicine field. Results showed standing position more significantly affects activity of transversus abdominis. Standing position seems to elevate activity of abdominal muscles out of truncus muscles including transversus abdominis more than supine position 20. Standing position maintains posture stability by inducing activity of muscles concerned with truncus stability such as the transversus abdominis 21. Thus breathing capacity increased as subjects neared upright angle in this study as well. Morgan 16 study, out of many research into respiratory functions according to posture change on normal persons, asserted the abdominal exercise theory: That abdominal muscles weaken and pulmonary functions decrease in supine position and gravity is supported by increased abdominal muscles while contraction of the diaphragm increases intercostal muscle activity in an upright position 16. Cardiopulmonary function is the most basic measure of respiratory function assessment and can be measured differently according to posture and angle 22. Basic cardiopulmonary functions are important for normal persons as well as clinical patients with neurological damage to carry out their daily lives independently 23. This study is deemed as sufficiently interconnected to treatment thus there is need for analytical research into diverse angles on patients. Also because this study set up safer treatment plans than actual clinical treatment, it could be used as reference. Limitations of this research are that the results cannot be generalized for all persons because it was conducted on healthy adults. Thus future research into respiratory functions must be systematic and intensive research on patients is needed. 5. Conclusion The purpose of this study was to understand respiratory function changes according to angle variation of 0, 45 and 90. Results showed breathing capacity average increased as the angle neared standing angle. Clinically using tilting beds for patient treatment could contribute to increasing breathing efficiency according to different angles. 6. References 1. Pryor JA, Prasad SA. Physio therapy for respiratory and cardiac problems, Singapore, Churchill Livingstone; Levagie PK, Norkin CC. Joint structure and function: A comprehensive analysis. FA Davis. Philadelphia; Frownfelter D, Dean E. Cardiovascular and pulmonary Physical Therapy - Evidence and Practice Philadelphia, Mosby; Silveira W, Mello FC, Guimarães FS, Menezes SL. Postural alterations and pulmonary function of mouth-breathing children. Braz J Otorhinolaryngol. 2010; 76(6): Song JY, Sim HV, Current ME. A Comparison of Vital Capacity Values with Healthy Subjects in standing and Head-Down Positions. Phys Ther Kor. 1996; 3(1): Mori RL, Bergsman AE, Holmes MJ. Role of the medial medullary reticular formation in relaying vestibular signals to the diaphragm and abdominal muscles. Brain. Research. 2001; 902(1): Pires MG, Di Francesco RC, Grumach AS, MellJF Jr. Evaluation of inspiratory pressure in children with enlarged tonsils and adenoids. Braz J Otorhinolaryngol. 2005; 71(5): Seo KC, Lee SE, Lee JH, Kim K. Comparison of Posture on Respiratory Function in the Stroke Patients according to Changes of Position. J Korean Soc Phys Ther. 2011; 6(4): Shin YA, Kim MJ, Ahn JH. The comparison of heart rate variability and blood pressure according to posture and exercise type. Exercise Science. 2011; 20(3): Kapleri E, Vourazanis E, Strimpakos N. Neck pain causes respiratory dysfunction. Medical hypotheses. 2008; 70(5): Lee BK. The Effect Of The Forced Pulmonary Function of Young Female by Changes in Lung Function Related to Postures and by Transverse Abdominis Activation in Standing Position. J Korean Soc Phys Ther. 2012; 7(3): Gorini M, Colagrande M, Gorini I, Iandelli M, Duranti G. In vivo ultrasound assessment of respiratory function of abdominal muscles in normal subjects. European Respiratory Society. 1997; 10(12): Skinner JS. Exercise testing and exercise prescription for special cases: Theoretical basis and clinical application. Lippincott Williams and Wilkins; Dimitriadis Z, Kapreli E, Strimpakos N. Respiratory weakness in patients with chronic neck pain. Man Ther. 2013; 18(3): Kim IB, Kim EK, Kang JH. The influence of position change on autonomic nervous system function. J Korean Soc Phys Ther. 2014; 9(1): Morgan MD, Gourlay AR, Silver JR et al. Contribution of the rib cage to breathing in tetraplegia. Thorax. 1986; 40(8): Kim K, Seo KC. The effect of pulmonary function and chest length in the stroke patients after feedback breathing Vol 8 (26) October Indian Journal of Science and Technology 5

6 Effects of Various Angle on Respiration Function in Adults exercise among position changes. J Spec Edu Reha Sci. 1986; 49(3): Barrett J, Cerny F, Hirsch A, Bishop B. Control of breathing patterns and abdominal muscles during graded loads and tilt. Applied Physiology. 1994; 76(6): Alethé GF, Faria AG, Ribeiro MA, Marson FAL, Schivinski CI, Ribeiro JD et al. Effect of exercise test on pulmonary function of obese adolescents. Pediatr. 2014; 90(3): Manshadi FD, Parnianpour M, Sarrafzadeh J et al. Abdominal hollowing and lateral abdominal wall muscles activity in both healthy men and women: An ultrasonic assessment in supine and standing positions. J Bodyw Mov Ther. 2011; 15(1): Neumann P, Gill V. Pelvic floor and abdominal muscle interaction: EMG activity and intra-abdominal pressure. International Urogynecology. 2002; 13(2): Beate K, Christoph S, Ralf E, Henry V, Anne O, Nele F, et al. Lung function reference values in different German. Scinece Direct Respiratory Medicine. 2002; 105(3): Kim SY, Kim NS, Jung JH, Jo MR. Effect of Forward Head Posture on Respiratory Function in Young Adults. J Korean Soc Phys Ther. 2013; 25(5): Vol 8 (26) October Indian Journal of Science and Technology