Metodologia de um

estudo de investigação
Projeto em Fisioterapia
Metodologia

This part is the core of your paper as

it is a proof that you use the scien1fic
method.

Through this section, your study’s

validity is judged.
Metodologia
Metodologia

How did you collect or

generate the data?

How did you analyze the

data?
Metodologia

Provide sufficient information of the

whole process so that others could
replicate your study.
• giving a completely accurate description of the
data collection equipments and the
techniques.
• explaining how you collected the data and
analysed them.
Metodologia

Include enough information so that

• others could repeat the experiment and evaluate whether the results
are reproducible.
• the audience can judge whether the results and conclusions are valid.

The explanation of the collection and the analysis of

your data is very important because
• readers need to know the reasons why you chose a particular method
or procedure instead of others.
• readers need to know that the collection or the generation of the
data is valid in the field of study.
Metodologia

Discuss the anticipated problems in

the process of the data collection and
the steps you took to prevent them.

Present the rationale for why you

chose specific experimental
procedures.
Conteúdo de uma metodologia
üDesenho de estudo
üAmostra
üConsiderações éticas
üInstrumentos
üProcedimentos – de recolha de dados/ intervenção
(pode incluir o processamento de dados)
üProcedimentos estatísticos
Antes de mais...
üForam seguidas algumas recomendações para a
preparação do manuscrito?

üIndicar qual a guideline usada... CONSORT?

STROBE?
Desenho de estudo

Classificação

• Metodologia de investigação quantitativa ou

qualitativa?
• RCT, observacional analítico transversal, …

Jus-ficação (breve descrição) da

adequação – NÃO é obrigatório
 Respiratory Physiology & Neurobiology 238 (2017) 14–22

Contents lists available at ScienceDirect

Respiratory Physiology & Neurobiology

journal homepage: www.elsevier.com/locate/resphysiol

Desenho de estudo Abdominal muscle activity during breathing in different postures in

COPD “Stage 0” and healthy subjects
António Mesquita Montes a,b,∗ , Joana Maia c , Carlos Crasto a , Cristina Argel de Melo a ,
Paulo Carvalho a , Rita Santos a , Susana Pereira d , João Paulo Vilas-Boas b
a
Department of Physiotherapy, and Activity and Human Movement Study Center (CEMAH), School of Allied Health Technologies, Polytechnic Institute of
Porto, Rua Dr. António Bernardino de Almeida 400, 4200-072 Porto, Portugal
b
Faculty of Sport, CIFI2D, and Porto Biomechanics Laboratory (LABIOMEP), University of Porto, Rua Dr. Plácido Costa 91, 4200-450 Porto, Portugal
c
Physiotherapist, Private Practice, Portugal
d
Cardiovascular, Respiratory and Sleep Technician, Private Practice, Portugal

a r t i c l e i n f o a b s t r a c t

Article history: This study aims to evaluate the effect of different postures on the abdominal muscle activity during
Received 13 October 2016 breathing in subjects “at risk” for the development of chronic obstructive pulmonary disease (COPD) and
Received in revised form healthy. Twenty-nine volunteers, divided in “At Risk” for COPD (n = 16; 47.38 ± 5.08 years) and Healthy
16 December 2016
(n = 13; 47.54 ± 6.65 years) groups, breathed at the same rhythm in supine, standing, tripod and 4-point-
Accepted 2 January 2017
Available online 7 January 2017
kneeling positions. Surface electromyography was performed to assess the activation intensity of rectus
abdominis, external oblique and transversus abdominis/internal oblique (TrA/IO) muscles, during inspi-
ration and expiration. From supine to standing, an increased activation of all abdominal muscles was
Keywords:
GOLD “Stage 0” observed in “At Risk” for COPD group; however, in Healthy group, TrA/IO muscle showed an increased acti-
Respiration vation. In both groups, the TrA/IO muscle activation in tripod and 4-point kneeling positions was higher
Postural control than in supine and lower than in standing. Subjects “at risk” for the development of COPD seemed to have
Core abdominal a specific recruitment of the superficial layer of ventrolateral abdominal wall for the synchronization of
Body position postural function and mechanics of breathing.
© 2017 Elsevier B.V. All rights reserved.

1. Introduction a changed thoraco-abdominal movement (Martinez et al., 1990).

Chronic Obstructive Pulmonary Disease (COPD) is described as
the presence of persistent airflow limitation that is usually pro-
gressive and associated with an enhanced chronic inflammatory
response in the airways (Global Initiative for Chronic Obstructive
Lung Disease, 2016; Vestbo et al., 2013). This obstructive ventila-
tory defect increases the volume of air in the lungs at the end of
expiration, keeping the inspiratory muscles, especially diaphragm,
in a mechanically disadvantaged position, which decreases their
ability to generate inspiratory pressure (O’Donnell, 2001). This
intrinsic mechanical loading of diaphragm muscle in COPD sub-
jects (De Troyer et al., 1997; Gorini et al., 1990) presumably results
in an increased activity of the accessory muscles of inspiration
(Gandevia et al., 1996) and expiration (Ninane et al., 1992) and
∗ Corresponding author at: Department of Physiotherapy, and Activity and Human
Movement Study Center (CEMAH), School of Allied Health Technologies, Polytechnic
Institute of Porto, Rua Valente Perfeito 322, 4400-330, Vila Nova de Gaia, Portugal.
E-mail address: antoniomesquitamontes@gmail.com (A. Mesquita Montes).
This increased activity of trunk muscles in COPD may imply a chal-
lenge for the synchronization of postural function and mechanics
of breathing (Smith et al., 2010).
The central nervous system (CNS) modulates the motor activi-
ties of trunk muscles during both postural control and respiratory
functions to regulate the intra-abdominal and intra-thoracic pres-
sures (Hodges et al., 2001). This modulation occurs as a result
of the coordination of the activity of abdominal, pelvic floor and
diaphragm muscles (Hodges and Gandevia, 2000). Regarding trunk
muscles’ dual task, the change of body orientation in space alters
their configuration and length and, consequently, the ability of res-
piratory muscles to act during breathing (De Troyer et al., 1983).
Such modifications in mechanical efficiency may be due to the
action of gravity and the changes in the base of support on the
activity of trunk muscles required for the maintenance of posture
(Meadows and Williams, 2009; Mihailoff and Haines, 2013). This
affects the compliance of ribcage and abdomen (Estenne et al.,
1985), changing the thoraco-abdominal configuration and move-
ment (Lee et al., 2010; Romei et al., 2010), and, consequently, the

http://dx.doi.org/10.1016/j.resp.2017.01.001
1569-9048/© 2017 Elsevier B.V. All rights reserved.
Amostra

População-alvo

Processo de recrutamento da amostra

Critérios de inclusão e exclusão

 Respiratory Physiology & Neurobiology 238 (2017) 14–22

Contents lists available at ScienceDirect

Respiratory Physiology & Neurobiology

journal homepage: www.elsevier.com/locate/resphysiol

Desenho de estudo Abdominal muscle activity during breathing in different postures in

COPD “Stage 0” and healthy subjects
António Mesquita Montes a,b,∗ , Joana Maia c , Carlos Crasto a , Cristina Argel de Melo a ,
Paulo Carvalho a , Rita Santos a , Susana Pereira d , João Paulo Vilas-Boas b
a
Department of Physiotherapy, and Activity and Human Movement Study Center (CEMAH), School of Allied Health Technologies, Polytechnic Institute of
Porto, Rua Dr. António Bernardino de Almeida 400, 4200-072 Porto, Portugal
b
Faculty of Sport, CIFI2D, and Porto Biomechanics Laboratory (LABIOMEP), University of Porto, Rua Dr. Plácido Costa 91, 4200-450 Porto, Portugal
c
Physiotherapist, Private Practice, Portugal
d
Cardiovascular, Respiratory and Sleep Technician, Private Practice, Portugal

a r t i c l e i n f o a b s t r a c t

Article history: This study aims to evaluate the effect of different postures on the abdominal muscle activity during
Received 13 October 2016 breathing in subjects “at risk” for the development of chronic obstructive pulmonary disease (COPD) and
Received in revised form healthy. Twenty-nine volunteers, divided in “At Risk” for COPD (n = 16; 47.38 ± 5.08 years) and Healthy
16 December 2016
(n = 13; 47.54 ± 6.65 years) groups, breathed at the same rhythm in supine, standing, tripod and 4-point-
Accepted 2 January 2017
Available online 7 January 2017
kneeling positions. Surface electromyography was performed to assess the activation intensity of rectus
abdominis, external oblique and transversus abdominis/internal oblique (TrA/IO) muscles, during inspi-
ration and expiration. From supine to standing, an increased activation of all abdominal muscles was
Keywords:
GOLD “Stage 0” observed in “At Risk” for COPD group; however, in Healthy group, TrA/IO muscle showed an increased acti-
Respiration vation. In both groups, the TrA/IO muscle activation in tripod and 4-point kneeling positions was higher
Postural control than in supine and lower than in standing. Subjects “at risk” for the development of COPD seemed to have
Core abdominal a specific recruitment of the superficial layer of ventrolateral abdominal wall for the synchronization of
Body position postural function and mechanics of breathing.
© 2017 Elsevier B.V. All rights reserved.

1. Introduction a changed thoraco-abdominal movement (Martinez et al., 1990).

Chronic Obstructive Pulmonary Disease (COPD) is described as
the presence of persistent airflow limitation that is usually pro-
gressive and associated with an enhanced chronic inflammatory
response in the airways (Global Initiative for Chronic Obstructive
Lung Disease, 2016; Vestbo et al., 2013). This obstructive ventila-
tory defect increases the volume of air in the lungs at the end of
expiration, keeping the inspiratory muscles, especially diaphragm,
in a mechanically disadvantaged position, which decreases their
ability to generate inspiratory pressure (O’Donnell, 2001). This
intrinsic mechanical loading of diaphragm muscle in COPD sub-
jects (De Troyer et al., 1997; Gorini et al., 1990) presumably results
in an increased activity of the accessory muscles of inspiration
(Gandevia et al., 1996) and expiration (Ninane et al., 1992) and
This increased activity of trunk muscles in COPD may imply a chal-
lenge for the synchronization of postural function and mechanics
of breathing (Smith et al., 2010).
The central nervous system (CNS) modulates the motor activi-
ties of trunk muscles during both postural control and respiratory
functions to regulate the intra-abdominal and intra-thoracic pres-
sures (Hodges et al., 2001). This modulation occurs as a result
of the coordination of the activity of abdominal, pelvic floor and
diaphragm muscles (Hodges and Gandevia, 2000). Regarding trunk
muscles’ dual task, the change of body orientation in space alters
their configuration and length and, consequently, the ability of res-
piratory muscles to act during breathing (De Troyer et al., 1983).
Such modifications in mechanical efficiency may be due to the
action of gravity and the changes in the base of support on the
activity of trunk muscles required for the maintenance of posture

Processo de recrutamento
(Meadows and Williams, 2009; Mihailoff and Haines, 2013). This

População-alvo
affects the compliance of ribcage and abdomen (Estenne et al.,
∗ Corresponding author at: Department of Physiotherapy, and Activity and Human 1985), changing the thoraco-abdominal configuration and move-
Movement Study Center (CEMAH), School of Allied Health Technologies, Polytechnic ment (Lee et al., 2010; Romei et al., 2010), and, consequently, the
Institute of Porto, Rua Valente Perfeito 322, 4400-330, Vila Nova de Gaia, Portugal.
E-mail address: antoniomesquitamontes@gmail.com (A. Mesquita Montes).

da amostra
http://dx.doi.org/10.1016/j.resp.2017.01.001
1569-9048/© 2017 Elsevier B.V. All rights reserved.
 Respiratory Physiology & Neurobiology 238 (2017) 14–22

Contents lists available at ScienceDirect

Respiratory Physiology & Neurobiology

journal homepage: www.elsevier.com/locate/resphysiol

Amostra Abdominal muscle activity during breathing in different postures in

COPD “Stage 0” and healthy subjects
António Mesquita Montes a,b,∗ , Joana Maia c , Carlos Crasto a , Cristina Argel de Melo a ,
Paulo Carvalho a , Rita Santos a , Susana Pereira d , João Paulo Vilas-Boas b
a
Department of Physiotherapy, and Activity and Human Movement Study Center (CEMAH), School of Allied Health Technologies, Polytechnic Institute of
Porto, Rua Dr. António Bernardino de Almeida 400, 4200-072 Porto, Portugal
b
Faculty of Sport, CIFI2D, and Porto Biomechanics Laboratory (LABIOMEP), University of Porto, Rua Dr. Plácido Costa 91, 4200-450 Porto, Portugal

Critérios de
c
Physiotherapist, Private Practice, Portugal
d
Cardiovascular, Respiratory and Sleep Technician, Private Practice, Portugal

a r t i c l e i n f o a b s t r a c t

Article history: This study aims to evaluate the effect of different postures on the abdominal muscle activity during
Received 13 October 2016 breathing in subjects “at risk” for the development of chronic obstructive pulmonary disease (COPD) and

inclusão
Received in revised form healthy. Twenty-nine volunteers, divided in “At Risk” for COPD (n = 16; 47.38 ± 5.08 years) and Healthy
16 December 2016
(n = 13; 47.54 ± 6.65 years) groups, breathed at the same rhythm in supine, standing, tripod and 4-point-
Accepted 2 January 2017
Available online 7 January 2017
kneeling positions. Surface electromyography was performed to assess the activation intensity of rectus
abdominis, external oblique and transversus abdominis/internal oblique (TrA/IO) muscles, during inspi-
ration and expiration. From supine to standing, an increased activation of all abdominal muscles was
Keywords:
GOLD “Stage 0” observed in “At Risk” for COPD group; however, in Healthy group, TrA/IO muscle showed an increased acti-
Respiration vation. In both groups, the TrA/IO muscle activation in tripod and 4-point kneeling positions was higher
Postural control than in supine and lower than in standing. Subjects “at risk” for the development of COPD seemed to have
Core abdominal a specific recruitment of the superficial layer of ventrolateral abdominal wall for the synchronization of
Body position postural function and mechanics of breathing.
© 2017 Elsevier B.V. All rights reserved.

1. Introduction a changed thoraco-abdominal movement (Martinez et al., 1990).

Chronic Obstructive Pulmonary Disease (COPD) is described as
the presence of persistent airflow limitation that is usually pro-
gressive and associated with an enhanced chronic inflammatory
response in the airways (Global Initiative for Chronic Obstructive
Lung Disease, 2016; Vestbo et al., 2013). This obstructive ventila-
tory defect increases the volume of air in the lungs at the end of
expiration, keeping the inspiratory muscles, especially diaphragm,
in a mechanically disadvantaged position, which decreases their
ability to generate inspiratory pressure (O’Donnell, 2001). This
intrinsic mechanical loading of diaphragm muscle in COPD sub-
jects (De Troyer et al., 1997; Gorini et al., 1990) presumably results
in an increased activity of the accessory muscles of inspiration
(Gandevia et al., 1996) and expiration (Ninane et al., 1992) and
∗ Corresponding author at: Department of Physiotherapy, and Activity and Human
Movement Study Center (CEMAH), School of Allied Health Technologies, Polytechnic
Institute of Porto, Rua Valente Perfeito 322, 4400-330, Vila Nova de Gaia, Portugal.
E-mail address: antoniomesquitamontes@gmail.com (A. Mesquita Montes).
This increased activity of trunk muscles in COPD may imply a chal-
lenge for the synchronization of postural function and mechanics
of breathing (Smith et al., 2010).
The central nervous system (CNS) modulates the motor activi-
ties of trunk muscles during both postural control and respiratory
functions to regulate the intra-abdominal and intra-thoracic pres-
sures (Hodges et al., 2001). This modulation occurs as a result
of the coordination of the activity of abdominal, pelvic floor and
diaphragm muscles (Hodges and Gandevia, 2000). Regarding trunk
muscles’ dual task, the change of body orientation in space alters
their configuration and length and, consequently, the ability of res-
piratory muscles to act during breathing (De Troyer et al., 1983).
Such modifications in mechanical efficiency may be due to the
action of gravity and the changes in the base of support on the
activity of trunk muscles required for the maintenance of posture
(Meadows and Williams, 2009; Mihailoff and Haines, 2013). This
affects the compliance of ribcage and abdomen (Estenne et al.,
1985), changing the thoraco-abdominal configuration and move-
ment (Lee et al., 2010; Romei et al., 2010), and, consequently, the

http://dx.doi.org/10.1016/j.resp.2017.01.001
1569-9048/© 2017 Elsevier B.V. All rights reserved.
 Respiratory Physiology & Neurobiology 238 (2017) 14–22

Contents lists available at ScienceDirect

Respiratory Physiology & Neurobiology

journal homepage: www.elsevier.com/locate/resphysiol

Amostra Abdominal muscle activity during breathing in different postures in

COPD “Stage 0” and healthy subjects
António Mesquita Montes a,b,∗ , Joana Maia c , Carlos Crasto a , Cristina Argel de Melo a ,
Paulo Carvalho a , Rita Santos a , Susana Pereira d , João Paulo Vilas-Boas b
a
Department of Physiotherapy, and Activity and Human Movement Study Center (CEMAH), School of Allied Health Technologies, Polytechnic Institute of
Porto, Rua Dr. António Bernardino de Almeida 400, 4200-072 Porto, Portugal
b
Faculty of Sport, CIFI2D, and Porto Biomechanics Laboratory (LABIOMEP), University of Porto, Rua Dr. Plácido Costa 91, 4200-450 Porto, Portugal

Critérios de
c
Physiotherapist, Private Practice, Portugal
d
Cardiovascular, Respiratory and Sleep Technician, Private Practice, Portugal

a r t i c l e i n f o a b s t r a c t

Article history: This study aims to evaluate the effect of different postures on the abdominal muscle activity during
Received 13 October 2016 breathing in subjects “at risk” for the development of chronic obstructive pulmonary disease (COPD) and

inclusão
Received in revised form healthy. Twenty-nine volunteers, divided in “At Risk” for COPD (n = 16; 47.38 ± 5.08 years) and Healthy
16 December 2016
(n = 13; 47.54 ± 6.65 years) groups, breathed at the same rhythm in supine, standing, tripod and 4-point-
Accepted 2 January 2017
Available online 7 January 2017
kneeling positions. Surface electromyography was performed to assess the activation intensity of rectus
abdominis, external oblique and transversus abdominis/internal oblique (TrA/IO) muscles, during inspi-
ration and expiration. From supine to standing, an increased activation of all abdominal muscles was
Keywords:
GOLD “Stage 0” observed in “At Risk” for COPD group; however, in Healthy group, TrA/IO muscle showed an increased acti-
Respiration vation. In both groups, the TrA/IO muscle activation in tripod and 4-point kneeling positions was higher
Postural control than in supine and lower than in standing. Subjects “at risk” for the development of COPD seemed to have
Core abdominal a specific recruitment of the superficial layer of ventrolateral abdominal wall for the synchronization of
Body position postural function and mechanics of breathing.
© 2017 Elsevier B.V. All rights reserved.

1. Introduction a changed thoraco-abdominal movement (Martinez et al., 1990).

Chronic Obstructive Pulmonary Disease (COPD) is described as
the presence of persistent airflow limitation that is usually pro-
gressive and associated with an enhanced chronic inflammatory
response in the airways (Global Initiative for Chronic Obstructive
Lung Disease, 2016; Vestbo et al., 2013). This obstructive ventila-
tory defect increases the volume of air in the lungs at the end of
expiration, keeping the inspiratory muscles, especially diaphragm,
in a mechanically disadvantaged position, which decreases their
ability to generate inspiratory pressure (O’Donnell, 2001). This
intrinsic mechanical loading of diaphragm muscle in COPD sub-
jects (De Troyer et al., 1997; Gorini et al., 1990) presumably results
in an increased activity of the accessory muscles of inspiration
(Gandevia et al., 1996) and expiration (Ninane et al., 1992) and
∗ Corresponding author at: Department of Physiotherapy, and Activity and Human
Movement Study Center (CEMAH), School of Allied Health Technologies, Polytechnic
Institute of Porto, Rua Valente Perfeito 322, 4400-330, Vila Nova de Gaia, Portugal.
E-mail address: antoniomesquitamontes@gmail.com (A. Mesquita Montes).
This increased activity of trunk muscles in COPD may imply a chal-
lenge for the synchronization of postural function and mechanics
of breathing (Smith et al., 2010).
The central nervous system (CNS) modulates the motor activi-
ties of trunk muscles during both postural control and respiratory
functions to regulate the intra-abdominal and intra-thoracic pres-
sures (Hodges et al., 2001). This modulation occurs as a result
of the coordination of the activity of abdominal, pelvic floor and
diaphragm muscles (Hodges and Gandevia, 2000). Regarding trunk
muscles’ dual task, the change of body orientation in space alters
their configuration and length and, consequently, the ability of res-
piratory muscles to act during breathing (De Troyer et al., 1983).
Such modifications in mechanical efficiency may be due to the
action of gravity and the changes in the base of support on the
activity of trunk muscles required for the maintenance of posture
(Meadows and Williams, 2009; Mihailoff and Haines, 2013). This
affects the compliance of ribcage and abdomen (Estenne et al.,
1985), changing the thoraco-abdominal configuration and move-
ment (Lee et al., 2010; Romei et al., 2010), and, consequently, the

http://dx.doi.org/10.1016/j.resp.2017.01.001
1569-9048/© 2017 Elsevier B.V. All rights reserved.

Eu voltava a
reescrever... O quê?
 Respiratory Physiology & Neurobiology 238 (2017) 14–22

Contents lists available at ScienceDirect

Respiratory Physiology & Neurobiology

journal homepage: www.elsevier.com/locate/resphysiol

Amostra Abdominal muscle activity during breathing in different postures in

COPD “Stage 0” and healthy subjects
António Mesquita Montes a,b,∗ , Joana Maia c , Carlos Crasto a , Cristina Argel de Melo a ,
Paulo Carvalho a , Rita Santos a , Susana Pereira d , João Paulo Vilas-Boas b
a
Department of Physiotherapy, and Activity and Human Movement Study Center (CEMAH), School of Allied Health Technologies, Polytechnic Institute of
Porto, Rua Dr. António Bernardino de Almeida 400, 4200-072 Porto, Portugal
b
Faculty of Sport, CIFI2D, and Porto Biomechanics Laboratory (LABIOMEP), University of Porto, Rua Dr. Plácido Costa 91, 4200-450 Porto, Portugal
c
Physiotherapist, Private Practice, Portugal
d
Cardiovascular, Respiratory and Sleep Technician, Private Practice, Portugal

a r t i c l e i n f o a b s t r a c t

Article history: This study aims to evaluate the effect of different postures on the abdominal muscle activity during
Received 13 October 2016 breathing in subjects “at risk” for the development of chronic obstructive pulmonary disease (COPD) and
Received in revised form healthy. Twenty-nine volunteers, divided in “At Risk” for COPD (n = 16; 47.38 ± 5.08 years) and Healthy
16 December 2016
(n = 13; 47.54 ± 6.65 years) groups, breathed at the same rhythm in supine, standing, tripod and 4-point-
Accepted 2 January 2017
Available online 7 January 2017
kneeling positions. Surface electromyography was performed to assess the activation intensity of rectus
abdominis, external oblique and transversus abdominis/internal oblique (TrA/IO) muscles, during inspi-
ration and expiration. From supine to standing, an increased activation of all abdominal muscles was
Keywords:
GOLD “Stage 0” observed in “At Risk” for COPD group; however, in Healthy group, TrA/IO muscle showed an increased acti-
Respiration vation. In both groups, the TrA/IO muscle activation in tripod and 4-point kneeling positions was higher
Postural control than in supine and lower than in standing. Subjects “at risk” for the development of COPD seemed to have
Core abdominal a specific recruitment of the superficial layer of ventrolateral abdominal wall for the synchronization of
Body position postural function and mechanics of breathing.
© 2017 Elsevier B.V. All rights reserved.

1. Introduction a changed thoraco-abdominal movement (Martinez et al., 1990).

Chronic Obstructive Pulmonary Disease (COPD) is described as
the presence of persistent airflow limitation that is usually pro-
gressive and associated with an enhanced chronic inflammatory
response in the airways (Global Initiative for Chronic Obstructive
Lung Disease, 2016; Vestbo et al., 2013). This obstructive ventila-
tory defect increases the volume of air in the lungs at the end of
expiration, keeping the inspiratory muscles, especially diaphragm,
in a mechanically disadvantaged position, which decreases their
ability to generate inspiratory pressure (O’Donnell, 2001). This
intrinsic mechanical loading of diaphragm muscle in COPD sub-
jects (De Troyer et al., 1997; Gorini et al., 1990) presumably results
in an increased activity of the accessory muscles of inspiration
(Gandevia et al., 1996) and expiration (Ninane et al., 1992) and
∗ Corresponding author at: Department of Physiotherapy, and Activity and Human
Movement Study Center (CEMAH), School of Allied Health Technologies, Polytechnic
Institute of Porto, Rua Valente Perfeito 322, 4400-330, Vila Nova de Gaia, Portugal.
E-mail address: antoniomesquitamontes@gmail.com (A. Mesquita Montes).
This increased activity of trunk muscles in COPD may imply a chal-
lenge for the synchronization of postural function and mechanics
of breathing (Smith et al., 2010).
The central nervous system (CNS) modulates the motor activi-
ties of trunk muscles during both postural control and respiratory
functions to regulate the intra-abdominal and intra-thoracic pres-
sures (Hodges et al., 2001). This modulation occurs as a result
of the coordination of the activity of abdominal, pelvic floor and
diaphragm muscles (Hodges and Gandevia, 2000). Regarding trunk
muscles’ dual task, the change of body orientation in space alters
their configuration and length and, consequently, the ability of res-
piratory muscles to act during breathing (De Troyer et al., 1983).
Such modifications in mechanical efficiency may be due to the
action of gravity and the changes in the base of support on the
activity of trunk muscles required for the maintenance of posture
(Meadows and Williams, 2009; Mihailoff and Haines, 2013). This
affects the compliance of ribcage and abdomen (Estenne et al.,
1985), changing the thoraco-abdominal configuration and move-
ment (Lee et al., 2010; Romei et al., 2010), and, consequently, the

http://dx.doi.org/10.1016/j.resp.2017.01.001
1569-9048/© 2017 Elsevier B.V. All rights reserved.

Critérios de
exclusão
Considerações éticas

Comissão de ética

Declaração de Helsínquia

Anonimato dos participantes

Confidencialidade dos dados

 Respiratory Physiology & Neurobiology 238 (2017) 14–22

Contents lists available at ScienceDirect

Respiratory Physiology & Neurobiology

journal homepage: www.elsevier.com/locate/resphysiol

Considerações é:cas Abdominal muscle activity during breathing in different postures in

COPD “Stage 0” and healthy subjects
António Mesquita Montes a,b,∗ , Joana Maia c , Carlos Crasto a , Cristina Argel de Melo a ,
Paulo Carvalho a , Rita Santos a , Susana Pereira d , João Paulo Vilas-Boas b
a
Department of Physiotherapy, and Activity and Human Movement Study Center (CEMAH), School of Allied Health Technologies, Polytechnic Institute of
Porto, Rua Dr. António Bernardino de Almeida 400, 4200-072 Porto, Portugal
b
Faculty of Sport, CIFI2D, and Porto Biomechanics Laboratory (LABIOMEP), University of Porto, Rua Dr. Plácido Costa 91, 4200-450 Porto, Portugal
c
Physiotherapist, Private Practice, Portugal
d
Cardiovascular, Respiratory and Sleep Technician, Private Practice, Portugal

a r t i c l e i n f o a b s t r a c t

Article history: This study aims to evaluate the effect of different postures on the abdominal muscle activity during
Received 13 October 2016 breathing in subjects “at risk” for the development of chronic obstructive pulmonary disease (COPD) and
Received in revised form healthy. Twenty-nine volunteers, divided in “At Risk” for COPD (n = 16; 47.38 ± 5.08 years) and Healthy
16 December 2016
(n = 13; 47.54 ± 6.65 years) groups, breathed at the same rhythm in supine, standing, tripod and 4-point-
Accepted 2 January 2017
Available online 7 January 2017
kneeling positions. Surface electromyography was performed to assess the activation intensity of rectus
abdominis, external oblique and transversus abdominis/internal oblique (TrA/IO) muscles, during inspi-
ration and expiration. From supine to standing, an increased activation of all abdominal muscles was
Keywords:
GOLD “Stage 0” observed in “At Risk” for COPD group; however, in Healthy group, TrA/IO muscle showed an increased acti-
Respiration vation. In both groups, the TrA/IO muscle activation in tripod and 4-point kneeling positions was higher
Postural control than in supine and lower than in standing. Subjects “at risk” for the development of COPD seemed to have
Core abdominal a specific recruitment of the superficial layer of ventrolateral abdominal wall for the synchronization of
Body position postural function and mechanics of breathing.
© 2017 Elsevier B.V. All rights reserved.

Considerações
1. Introduction
Chronic Obstructive Pulmonary Disease (COPD) is described as
the presence of persistent airflow limitation that is usually pro-
gressive and associated with an enhanced chronic inflammatory
response in the airways (Global Initiative for Chronic Obstructive
Lung Disease, 2016; Vestbo et al., 2013). This obstructive ventila-
a changed thoraco-abdominal movement (Martinez et al., 1990).
This increased activity of trunk muscles in COPD may imply a chal-
lenge for the synchronization of postural function and mechanics
of breathing (Smith et al., 2010).
The central nervous system (CNS) modulates the motor activi-
ties of trunk muscles during both postural control and respiratory
functions to regulate the intra-abdominal and intra-thoracic pres-

éticas
tory defect increases the volume of air in the lungs at the end of
expiration, keeping the inspiratory muscles, especially diaphragm,
in a mechanically disadvantaged position, which decreases their
ability to generate inspiratory pressure (O’Donnell, 2001). This
intrinsic mechanical loading of diaphragm muscle in COPD sub-
jects (De Troyer et al., 1997; Gorini et al., 1990) presumably results
in an increased activity of the accessory muscles of inspiration
(Gandevia et al., 1996) and expiration (Ninane et al., 1992) and
∗ Corresponding author at: Department of Physiotherapy, and Activity and Human
Movement Study Center (CEMAH), School of Allied Health Technologies, Polytechnic
Institute of Porto, Rua Valente Perfeito 322, 4400-330, Vila Nova de Gaia, Portugal.
E-mail address: antoniomesquitamontes@gmail.com (A. Mesquita Montes).
sures (Hodges et al., 2001). This modulation occurs as a result
of the coordination of the activity of abdominal, pelvic floor and
diaphragm muscles (Hodges and Gandevia, 2000). Regarding trunk
muscles’ dual task, the change of body orientation in space alters
their configuration and length and, consequently, the ability of res-
piratory muscles to act during breathing (De Troyer et al., 1983).
Such modifications in mechanical efficiency may be due to the
action of gravity and the changes in the base of support on the
activity of trunk muscles required for the maintenance of posture
(Meadows and Williams, 2009; Mihailoff and Haines, 2013). This
affects the compliance of ribcage and abdomen (Estenne et al.,
1985), changing the thoraco-abdominal configuration and move-
ment (Lee et al., 2010; Romei et al., 2010), and, consequently, the

http://dx.doi.org/10.1016/j.resp.2017.01.001
1569-9048/© 2017 Elsevier B.V. All rights reserved.
Instrumentos

De caracterização/ de avaliação

Marca e modelo

Validade e fiabilidade (se aplicável)

Graduação, erro ou precisão (se aplicável)

 Respiratory Physiology & Neurobiology 238 (2017) 14–22

Contents lists available at ScienceDirect

Respiratory Physiology & Neurobiology

journal homepage: www.elsevier.com/locate/resphysiol

Instrumentos Abdominal muscle activity during breathing in different postures in

COPD “Stage 0” and healthy subjects
António Mesquita Montes a,b,∗ , Joana Maia c , Carlos Crasto a , Cristina Argel de Melo a ,
Paulo Carvalho a , Rita Santos a , Susana Pereira d , João Paulo Vilas-Boas b
a
Department of Physiotherapy, and Activity and Human Movement Study Center (CEMAH), School of Allied Health Technologies, Polytechnic Institute of
Porto, Rua Dr. António Bernardino de Almeida 400, 4200-072 Porto, Portugal
b
Faculty of Sport, CIFI2D, and Porto Biomechanics Laboratory (LABIOMEP), University of Porto, Rua Dr. Plácido Costa 91, 4200-450 Porto, Portugal
c
Physiotherapist, Private Practice, Portugal
d
Cardiovascular, Respiratory and Sleep Technician, Private Practice, Portugal

a r t i c l e i n f o a b s t r a c t

Article history: This study aims to evaluate the effect of different postures on the abdominal muscle activity during
Received 13 October 2016 breathing in subjects “at risk” for the development of chronic obstructive pulmonary disease (COPD) and
Received in revised form

Instrumento Objetivo/ variável

healthy. Twenty-nine volunteers, divided in “At Risk” for COPD (n = 16; 47.38 ± 5.08 years) and Healthy
16 December 2016
(n = 13; 47.54 ± 6.65 years) groups, breathed at the same rhythm in supine, standing, tripod and 4-point-
Accepted 2 January 2017
Available online 7 January 2017
kneeling positions. Surface electromyography was performed to assess the activation intensity of rectus
abdominis, external oblique and transversus abdominis/internal oblique (TrA/IO) muscles, during inspi-
ration and expiration. From supine to standing, an increased activation of all abdominal muscles was
Keywords:
GOLD “Stage 0” observed in “At Risk” for COPD group; however, in Healthy group, TrA/IO muscle showed an increased acti-
Respiration vation. In both groups, the TrA/IO muscle activation in tripod and 4-point kneeling positions was higher
Postural control than in supine and lower than in standing. Subjects “at risk” for the development of COPD seemed to have
Core abdominal a specific recruitment of the superficial layer of ventrolateral abdominal wall for the synchronization of
Body position postural function and mechanics of breathing.
© 2017 Elsevier B.V. All rights reserved.

1. Introduction a changed thoraco-abdominal movement (Martinez et al., 1990).

Chronic Obstructive Pulmonary Disease (COPD) is described as
the presence of persistent airflow limitation that is usually pro-
gressive and associated with an enhanced chronic inflammatory
response in the airways (Global Initiative for Chronic Obstructive
Lung Disease, 2016; Vestbo et al., 2013). This obstructive ventila-
tory defect increases the volume of air in the lungs at the end of
expiration, keeping the inspiratory muscles, especially diaphragm,
in a mechanically disadvantaged position, which decreases their
ability to generate inspiratory pressure (O’Donnell, 2001). This
intrinsic mechanical loading of diaphragm muscle in COPD sub-
jects (De Troyer et al., 1997; Gorini et al., 1990) presumably results
in an increased activity of the accessory muscles of inspiration
(Gandevia et al., 1996) and expiration (Ninane et al., 1992) and
∗ Corresponding author at: Department of Physiotherapy, and Activity and Human
Movement Study Center (CEMAH), School of Allied Health Technologies, Polytechnic
Institute of Porto, Rua Valente Perfeito 322, 4400-330, Vila Nova de Gaia, Portugal.
E-mail address: antoniomesquitamontes@gmail.com (A. Mesquita Montes).
This increased activity of trunk muscles in COPD may imply a chal-
lenge for the synchronization of postural function and mechanics
of breathing (Smith et al., 2010).
The central nervous system (CNS) modulates the motor activi-
ties of trunk muscles during both postural control and respiratory
functions to regulate the intra-abdominal and intra-thoracic pres-
sures (Hodges et al., 2001). This modulation occurs as a result
of the coordination of the activity of abdominal, pelvic floor and
diaphragm muscles (Hodges and Gandevia, 2000). Regarding trunk
muscles’ dual task, the change of body orientation in space alters
their configuration and length and, consequently, the ability of res-
piratory muscles to act during breathing (De Troyer et al., 1983).
Such modifications in mechanical efficiency may be due to the
action of gravity and the changes in the base of support on the
activity of trunk muscles required for the maintenance of posture
(Meadows and Williams, 2009; Mihailoff and Haines, 2013). This
affects the compliance of ribcage and abdomen (Estenne et al.,
1985), changing the thoraco-abdominal configuration and move-
ment (Lee et al., 2010; Romei et al., 2010), and, consequently, the

http://dx.doi.org/10.1016/j.resp.2017.01.001
1569-9048/© 2017 Elsevier B.V. All rights reserved.

Marca e modelo
 Respiratory Physiology & Neurobiology 238 (2017) 14–22

Contents lists available at ScienceDirect

Respiratory Physiology & Neurobiology

journal homepage: www.elsevier.com/locate/resphysiol

Instrumentos Abdominal muscle activity during breathing in different postures in

COPD “Stage 0” and healthy subjects
António Mesquita Montes a,b,∗ , Joana Maia c , Carlos Crasto a , Cristina Argel de Melo a ,
Paulo Carvalho a , Rita Santos a , Susana Pereira d , João Paulo Vilas-Boas b
a
Department of Physiotherapy, and Activity and Human Movement Study Center (CEMAH), School of Allied Health Technologies, Polytechnic Institute of
Porto, Rua Dr. António Bernardino de Almeida 400, 4200-072 Porto, Portugal
b
Faculty of Sport, CIFI2D, and Porto Biomechanics Laboratory (LABIOMEP), University of Porto, Rua Dr. Plácido Costa 91, 4200-450 Porto, Portugal
c
Physiotherapist, Private Practice, Portugal
d
Cardiovascular, Respiratory and Sleep Technician, Private Practice, Portugal

a r t i c l e i n f o a b s t r a c t

Instrumento e objetivo Marca e modelo

Article history:
Received 13 October 2016
Received in revised form
16 December 2016
Accepted 2 January 2017
Available online 7 January 2017
This study aims to evaluate the effect of different postures on the abdominal muscle activity during
breathing in subjects “at risk” for the development of chronic obstructive pulmonary disease (COPD) and
healthy. Twenty-nine volunteers, divided in “At Risk” for COPD (n = 16; 47.38 ± 5.08 years) and Healthy
(n = 13; 47.54 ± 6.65 years) groups, breathed at the same rhythm in supine, standing, tripod and 4-point-
kneeling positions. Surface electromyography was performed to assess the activation intensity of rectus
abdominis, external oblique and transversus abdominis/internal oblique (TrA/IO) muscles, during inspi-
ration and expiration. From supine to standing, an increased activation of all abdominal muscles was
Keywords:
GOLD “Stage 0” observed in “At Risk” for COPD group; however, in Healthy group, TrA/IO muscle showed an increased acti-
Respiration vation. In both groups, the TrA/IO muscle activation in tripod and 4-point kneeling positions was higher
Postural control than in supine and lower than in standing. Subjects “at risk” for the development of COPD seemed to have
Core abdominal a specific recruitment of the superficial layer of ventrolateral abdominal wall for the synchronization of
Body position postural function and mechanics of breathing.
© 2017 Elsevier B.V. All rights reserved.

1. Introduction a changed thoraco-abdominal movement (Martinez et al., 1990).

Chronic Obstructive Pulmonary Disease (COPD) is described as
the presence of persistent airflow limitation that is usually pro-
gressive and associated with an enhanced chronic inflammatory
response in the airways (Global Initiative for Chronic Obstructive
Lung Disease, 2016; Vestbo et al., 2013). This obstructive ventila-
tory defect increases the volume of air in the lungs at the end of
expiration, keeping the inspiratory muscles, especially diaphragm,
in a mechanically disadvantaged position, which decreases their
ability to generate inspiratory pressure (O’Donnell, 2001). This
intrinsic mechanical loading of diaphragm muscle in COPD sub-
jects (De Troyer et al., 1997; Gorini et al., 1990) presumably results
in an increased activity of the accessory muscles of inspiration
(Gandevia et al., 1996) and expiration (Ninane et al., 1992) and
∗ Corresponding author at: Department of Physiotherapy, and Activity and Human
Movement Study Center (CEMAH), School of Allied Health Technologies, Polytechnic
Institute of Porto, Rua Valente Perfeito 322, 4400-330, Vila Nova de Gaia, Portugal.
E-mail address: antoniomesquitamontes@gmail.com (A. Mesquita Montes).
This increased activity of trunk muscles in COPD may imply a chal-
lenge for the synchronization of postural function and mechanics
of breathing (Smith et al., 2010).
The central nervous system (CNS) modulates the motor activi-
ties of trunk muscles during both postural control and respiratory
functions to regulate the intra-abdominal and intra-thoracic pres-
sures (Hodges et al., 2001). This modulation occurs as a result
of the coordination of the activity of abdominal, pelvic floor and
diaphragm muscles (Hodges and Gandevia, 2000). Regarding trunk
muscles’ dual task, the change of body orientation in space alters
their configuration and length and, consequently, the ability of res-
piratory muscles to act during breathing (De Troyer et al., 1983).
Such modifications in mechanical efficiency may be due to the
action of gravity and the changes in the base of support on the
activity of trunk muscles required for the maintenance of posture
(Meadows and Williams, 2009; Mihailoff and Haines, 2013). This
affects the compliance of ribcage and abdomen (Estenne et al.,
1985), changing the thoraco-abdominal configuration and move-
ment (Lee et al., 2010; Romei et al., 2010), and, consequently, the

http://dx.doi.org/10.1016/j.resp.2017.01.001
1569-9048/© 2017 Elsevier B.V. All rights reserved.

Graduação
 Respiratory Physiology & Neurobiology 238 (2017) 14–22

Contents lists available at ScienceDirect

Respiratory Physiology & Neurobiology

journal homepage: www.elsevier.com/locate/resphysiol

Instrumentos Abdominal muscle activity during breathing in different postures in

COPD “Stage 0” and healthy subjects
António Mesquita Montes a,b,∗ , Joana Maia c , Carlos Crasto a , Cristina Argel de Melo a ,
Paulo Carvalho a , Rita Santos a , Susana Pereira d , João Paulo Vilas-Boas b
a
Department of Physiotherapy, and Activity and Human Movement Study Center (CEMAH), School of Allied Health Technologies, Polytechnic Institute of
Porto, Rua Dr. António Bernardino de Almeida 400, 4200-072 Porto, Portugal
b
Faculty of Sport, CIFI2D, and Porto Biomechanics Laboratory (LABIOMEP), University of Porto, Rua Dr. Plácido Costa 91, 4200-450 Porto, Portugal
c
Physiotherapist, Private Practice, Portugal
d
Cardiovascular, Respiratory and Sleep Technician, Private Practice, Portugal

a r t i c l e i n f o a b s t r a c t

Article history: This study aims to evaluate the effect of different postures on the abdominal muscle activity during
Received 13 October 2016 breathing in subjects “at risk” for the development of chronic obstructive pulmonary disease (COPD) and
Received in revised form healthy. Twenty-nine volunteers, divided in “At Risk” for COPD (n = 16; 47.38 ± 5.08 years) and Healthy
16 December 2016
(n = 13; 47.54 ± 6.65 years) groups, breathed at the same rhythm in supine, standing, tripod and 4-point-
Accepted 2 January 2017
Available online 7 January 2017
kneeling positions. Surface electromyography was performed to assess the activation intensity of rectus
abdominis, external oblique and transversus abdominis/internal oblique (TrA/IO) muscles, during inspi-
ration and expiration. From supine to standing, an increased activation of all abdominal muscles was
Keywords:
GOLD “Stage 0” observed in “At Risk” for COPD group; however, in Healthy group, TrA/IO muscle showed an increased acti-
Respiration vation. In both groups, the TrA/IO muscle activation in tripod and 4-point kneeling positions was higher
Postural control than in supine and lower than in standing. Subjects “at risk” for the development of COPD seemed to have
Core abdominal a specific recruitment of the superficial layer of ventrolateral abdominal wall for the synchronization of
Body position postural function and mechanics of breathing.
© 2017 Elsevier B.V. All rights reserved.

1. Introduction a changed thoraco-abdominal movement (Martinez et al., 1990).

Chronic Obstructive Pulmonary Disease (COPD) is described as
the presence of persistent airflow limitation that is usually pro-
gressive and associated with an enhanced chronic inflammatory
response in the airways (Global Initiative for Chronic Obstructive
Lung Disease, 2016; Vestbo et al., 2013). This obstructive ventila-
tory defect increases the volume of air in the lungs at the end of
expiration, keeping the inspiratory muscles, especially diaphragm,
in a mechanically disadvantaged position, which decreases their
ability to generate inspiratory pressure (O’Donnell, 2001). This
intrinsic mechanical loading of diaphragm muscle in COPD sub-
jects (De Troyer et al., 1997; Gorini et al., 1990) presumably results
in an increased activity of the accessory muscles of inspiration
(Gandevia et al., 1996) and expiration (Ninane et al., 1992) and
∗ Corresponding author at: Department of Physiotherapy, and Activity and Human
Movement Study Center (CEMAH), School of Allied Health Technologies, Polytechnic
Institute of Porto, Rua Valente Perfeito 322, 4400-330, Vila Nova de Gaia, Portugal.
E-mail address: antoniomesquitamontes@gmail.com (A. Mesquita Montes).
This increased activity of trunk muscles in COPD may imply a chal-
lenge for the synchronization of postural function and mechanics
of breathing (Smith et al., 2010).
The central nervous system (CNS) modulates the motor activi-
ties of trunk muscles during both postural control and respiratory
functions to regulate the intra-abdominal and intra-thoracic pres-
sures (Hodges et al., 2001). This modulation occurs as a result
of the coordination of the activity of abdominal, pelvic floor and
diaphragm muscles (Hodges and Gandevia, 2000). Regarding trunk
muscles’ dual task, the change of body orientation in space alters
their configuration and length and, consequently, the ability of res-
piratory muscles to act during breathing (De Troyer et al., 1983).
Such modifications in mechanical efficiency may be due to the
action of gravity and the changes in the base of support on the
activity of trunk muscles required for the maintenance of posture
(Meadows and Williams, 2009; Mihailoff and Haines, 2013). This
affects the compliance of ribcage and abdomen (Estenne et al.,
1985), changing the thoraco-abdominal configuration and move-
ment (Lee et al., 2010; Romei et al., 2010), and, consequently, the

http://dx.doi.org/10.1016/j.resp.2017.01.001
1569-9048/© 2017 Elsevier B.V. All rights reserved.
Procedimentos

Estudo piloto

Recolha de dados
• Caracterização da amostra
• Dados em análise
Intervenção
Procedimentos – Processamento
de dados

Como obteve os
resultados?

Que cálculos foram

efetuados?
 Respiratory Physiology & Neurobiology 238 (2017) 14–22

Contents lists available at ScienceDirect

Respiratory Physiology & Neurobiology

Procedimentos – journal homepage: www.elsevier.com/locate/resphysiol

Abdominal muscle activity during breathing in different postures in

Processamento de dados
COPD “Stage 0” and healthy subjects
António Mesquita Montes a,b,∗ , Joana Maia c , Carlos Crasto a , Cristina Argel de Melo a ,
Paulo Carvalho a , Rita Santos a , Susana Pereira d , João Paulo Vilas-Boas b
a
Department of Physiotherapy, and Activity and Human Movement Study Center (CEMAH), School of Allied Health Technologies, Polytechnic Institute of
Porto, Rua Dr. António Bernardino de Almeida 400, 4200-072 Porto, Portugal
b
Faculty of Sport, CIFI2D, and Porto Biomechanics Laboratory (LABIOMEP), University of Porto, Rua Dr. Plácido Costa 91, 4200-450 Porto, Portugal
c
Physiotherapist, Private Practice, Portugal
d
Cardiovascular, Respiratory and Sleep Technician, Private Practice, Portugal

a r t i c l e i n f o a b s t r a c t

Article history: This study aims to evaluate the effect of different postures on the abdominal muscle activity during
Received 13 October 2016 breathing in subjects “at risk” for the development of chronic obstructive pulmonary disease (COPD) and
Received in revised form healthy. Twenty-nine volunteers, divided in “At Risk” for COPD (n = 16; 47.38 ± 5.08 years) and Healthy
16 December 2016
(n = 13; 47.54 ± 6.65 years) groups, breathed at the same rhythm in supine, standing, tripod and 4-point-
Accepted 2 January 2017
Available online 7 January 2017
kneeling positions. Surface electromyography was performed to assess the activation intensity of rectus
abdominis, external oblique and transversus abdominis/internal oblique (TrA/IO) muscles, during inspi-
ration and expiration. From supine to standing, an increased activation of all abdominal muscles was
Keywords:
GOLD “Stage 0” observed in “At Risk” for COPD group; however, in Healthy group, TrA/IO muscle showed an increased acti-
Respiration vation. In both groups, the TrA/IO muscle activation in tripod and 4-point kneeling positions was higher
Postural control than in supine and lower than in standing. Subjects “at risk” for the development of COPD seemed to have
Core abdominal a specific recruitment of the superficial layer of ventrolateral abdominal wall for the synchronization of
Body position postural function and mechanics of breathing.
© 2017 Elsevier B.V. All rights reserved.

1. Introduction a changed thoraco-abdominal movement (Martinez et al., 1990).

Chronic Obstructive Pulmonary Disease (COPD) is described as
the presence of persistent airflow limitation that is usually pro-
gressive and associated with an enhanced chronic inflammatory
response in the airways (Global Initiative for Chronic Obstructive
Lung Disease, 2016; Vestbo et al., 2013). This obstructive ventila-
tory defect increases the volume of air in the lungs at the end of
expiration, keeping the inspiratory muscles, especially diaphragm,
in a mechanically disadvantaged position, which decreases their
ability to generate inspiratory pressure (O’Donnell, 2001). This
intrinsic mechanical loading of diaphragm muscle in COPD sub-
jects (De Troyer et al., 1997; Gorini et al., 1990) presumably results
in an increased activity of the accessory muscles of inspiration
(Gandevia et al., 1996) and expiration (Ninane et al., 1992) and
∗ Corresponding author at: Department of Physiotherapy, and Activity and Human
Movement Study Center (CEMAH), School of Allied Health Technologies, Polytechnic
Institute of Porto, Rua Valente Perfeito 322, 4400-330, Vila Nova de Gaia, Portugal.
E-mail address: antoniomesquitamontes@gmail.com (A. Mesquita Montes).
This increased activity of trunk muscles in COPD may imply a chal-
lenge for the synchronization of postural function and mechanics
of breathing (Smith et al., 2010).
The central nervous system (CNS) modulates the motor activi-
ties of trunk muscles during both postural control and respiratory
functions to regulate the intra-abdominal and intra-thoracic pres-
sures (Hodges et al., 2001). This modulation occurs as a result
of the coordination of the activity of abdominal, pelvic floor and
diaphragm muscles (Hodges and Gandevia, 2000). Regarding trunk
muscles’ dual task, the change of body orientation in space alters
their configuration and length and, consequently, the ability of res-
piratory muscles to act during breathing (De Troyer et al., 1983).
Such modifications in mechanical efficiency may be due to the
action of gravity and the changes in the base of support on the
activity of trunk muscles required for the maintenance of posture
(Meadows and Williams, 2009; Mihailoff and Haines, 2013). This
affects the compliance of ribcage and abdomen (Estenne et al.,
1985), changing the thoraco-abdominal configuration and move-
ment (Lee et al., 2010; Romei et al., 2010), and, consequently, the

http://dx.doi.org/10.1016/j.resp.2017.01.001
1569-9048/© 2017 Elsevier B.V. All rights reserved.
 Respiratory Physiology & Neurobiology 238 (2017) 14–22

Contents lists available at ScienceDirect

Respiratory Physiology & Neurobiology

Procedimentos – journal homepage: www.elsevier.com/locate/resphysiol

Abdominal muscle activity during breathing in different postures in

Processamento de dados
COPD “Stage 0” and healthy subjects
António Mesquita Montes a,b,∗ , Joana Maia c , Carlos Crasto a , Cristina Argel de Melo a ,
Paulo Carvalho a , Rita Santos a , Susana Pereira d , João Paulo Vilas-Boas b
a
Department of Physiotherapy, and Activity and Human Movement Study Center (CEMAH), School of Allied Health Technologies, Polytechnic Institute of
Porto, Rua Dr. António Bernardino de Almeida 400, 4200-072 Porto, Portugal
b
Faculty of Sport, CIFI2D, and Porto Biomechanics Laboratory (LABIOMEP), University of Porto, Rua Dr. Plácido Costa 91, 4200-450 Porto, Portugal
c
Physiotherapist, Private Practice, Portugal
d
Cardiovascular, Respiratory and Sleep Technician, Private Practice, Portugal

a r t i c l e i n f o a b s t r a c t

Article history: This study aims to evaluate the effect of different postures on the abdominal muscle activity during
Received 13 October 2016 breathing in subjects “at risk” for the development of chronic obstructive pulmonary disease (COPD) and
Received in revised form healthy. Twenty-nine volunteers, divided in “At Risk” for COPD (n = 16; 47.38 ± 5.08 years) and Healthy
16 December 2016
(n = 13; 47.54 ± 6.65 years) groups, breathed at the same rhythm in supine, standing, tripod and 4-point-
Accepted 2 January 2017
Available online 7 January 2017
kneeling positions. Surface electromyography was performed to assess the activation intensity of rectus
abdominis, external oblique and transversus abdominis/internal oblique (TrA/IO) muscles, during inspi-
ration and expiration. From supine to standing, an increased activation of all abdominal muscles was
Keywords:
GOLD “Stage 0” observed in “At Risk” for COPD group; however, in Healthy group, TrA/IO muscle showed an increased acti-
Respiration vation. In both groups, the TrA/IO muscle activation in tripod and 4-point kneeling positions was higher
Postural control than in supine and lower than in standing. Subjects “at risk” for the development of COPD seemed to have
Core abdominal a specific recruitment of the superficial layer of ventrolateral abdominal wall for the synchronization of
Body position postural function and mechanics of breathing.
© 2017 Elsevier B.V. All rights reserved.

1. Introduction a changed thoraco-abdominal movement (Martinez et al., 1990).

Chronic Obstructive Pulmonary Disease (COPD) is described as
the presence of persistent airflow limitation that is usually pro-
gressive and associated with an enhanced chronic inflammatory
response in the airways (Global Initiative for Chronic Obstructive
Lung Disease, 2016; Vestbo et al., 2013). This obstructive ventila-
tory defect increases the volume of air in the lungs at the end of
expiration, keeping the inspiratory muscles, especially diaphragm,
in a mechanically disadvantaged position, which decreases their
ability to generate inspiratory pressure (O’Donnell, 2001). This
intrinsic mechanical loading of diaphragm muscle in COPD sub-
jects (De Troyer et al., 1997; Gorini et al., 1990) presumably results
in an increased activity of the accessory muscles of inspiration
(Gandevia et al., 1996) and expiration (Ninane et al., 1992) and
∗ Corresponding author at: Department of Physiotherapy, and Activity and Human
Movement Study Center (CEMAH), School of Allied Health Technologies, Polytechnic
Institute of Porto, Rua Valente Perfeito 322, 4400-330, Vila Nova de Gaia, Portugal.
E-mail address: antoniomesquitamontes@gmail.com (A. Mesquita Montes).
This increased activity of trunk muscles in COPD may imply a chal-
lenge for the synchronization of postural function and mechanics
of breathing (Smith et al., 2010).
The central nervous system (CNS) modulates the motor activi-
ties of trunk muscles during both postural control and respiratory
functions to regulate the intra-abdominal and intra-thoracic pres-
sures (Hodges et al., 2001). This modulation occurs as a result
of the coordination of the activity of abdominal, pelvic floor and
diaphragm muscles (Hodges and Gandevia, 2000). Regarding trunk
muscles’ dual task, the change of body orientation in space alters
their configuration and length and, consequently, the ability of res-
piratory muscles to act during breathing (De Troyer et al., 1983).
Such modifications in mechanical efficiency may be due to the
action of gravity and the changes in the base of support on the
activity of trunk muscles required for the maintenance of posture
(Meadows and Williams, 2009; Mihailoff and Haines, 2013). This
affects the compliance of ribcage and abdomen (Estenne et al.,
1985), changing the thoraco-abdominal configuration and move-
ment (Lee et al., 2010; Romei et al., 2010), and, consequently, the

http://dx.doi.org/10.1016/j.resp.2017.01.001
1569-9048/© 2017 Elsevier B.V. All rights reserved.
Estatística
Programa estatístico

Nível de significância / intervalo de confiança

Normalidade das variáveis

Estatística descritiva
• Tendência central: média, mediana, …
• Dispersão: desvio padrão, quartis 25/75, …
Estatística inferencial
• Paramétrica: test t para amostras emparelhadas, …
• Não-paramétrica: teste de Wilcoxon, …
Estatística

Programa Nível de
estatístico significância
Esta@s:ca

Normalidade das
variáveis
Estatística

Estatística
descritiva
Estatística
Estatística
inferencial
Obrigado pela
atenção!
Projeto em Fisioterapia