Balance recovery is compromised and trunk muscle activity is increased in chronic obstructive pulmonary disease
Introduction
Chronic obstructive pulmonary disease (COPD) has non-respiratory consequences, including impairments of muscle strength/endurance [1], [2] and balance [3], [4], which may increase risk of falling. The mechanisms underlying impaired balance in COPD are poorly understood; however, mediolateral (ML) balance control appears more impaired than anteroposterior (AP) control [4]. In quiet stance, ML balance depends on hip and trunk moments/movements, whereas AP balance is controlled by ankle moments/movements [5], [6]. One plausible explanation for ML balance compromise in COPD is reduced contribution of trunk muscles/moments to balance secondary to increased respiratory demand.
Excessive trunk muscle activity can compromise trunk movement, and reduced movement can compromise balance [7]. When respiratory demand is increased in individuals without disease by breathing with hypercapnoea, abdominal muscle activity to regain balance during unexpected surface translation [8] and lifting [9] is increased. Similar augmentation of trunk muscle activity in COPD might compromise balance. Evaluation of postural adjustments associated with arm movements tests both postural activity of trunk muscles [10] and balance recovery [11]. This study aimed to test the hypotheses that; balance recovery after postural disturbance would be compromised in COPD; and this would be accompanied by excessive trunk muscle activity secondary to the dual role of trunk muscles in respiration and posture.
Section snippets
Participants
Fifteen individuals with COPD and fifteen volunteers without respiratory disease matched for gender (9 males and 6 females/group), age (independent t-tests; p = 0.63), body mass index (p = 0.94) and activity level [12] (p = 0.10) participated (Table 1). Individuals with stable COPD were included if they had: forced expiratory volume in one second (FEV1) <50% predicted [13], <25% change in FEV1 after bronchodilation (to exclude asthma); and did not require home oxygen. Volunteers without respiratory
Respiratory variables
Respiratory rate was greater in participants with COPD than without, both before and after exercise (main effect group: p = 0.004, interaction Group × Exercise: p = 0.019, post-hoc: p < 0.023). Tidal volume did not differ between groups pre-exercise (0.94 (0.33) L vs. 0.95 (0.26) L; p = 0.18), but participants with COPD had greater tidal volume post-exercise (1.41 (1.15) L vs. 0.82 (0.20) L; p = 0.023). Mean post-exercise breathlessness was reported as 3.3/10 (1.6) by participants with COPD (“moderate”
Discussion
Results show compromised balance recovery in COPD which was accompanied by greater trunk muscle activity (above that required for breathing) associated with a simple balance perturbation. People with more severe COPD had greater OE and RA activity during breathing at rest (before arm movement) and when respiratory and postural demands were combined (after arm movement onset), and people with less severe COPD had increased OE and ES EMG following exercise. The congruence of observations of
Conclusion
This study identified that people with COPD have increased superficial abdominal muscle activity during postural tasks, and impaired ability to recover balance after postural perturbations. Trunk stiffness secondary to increased trunk muscle activity may limit the contribution of the trunk to the recovery and maintenance of balance; thus, increasing risk of falls. Further research is warranted to investigate the effect of reduction of trunk muscle activity on balance control, and the
Conflict of interest statement
None of the authors have any potential conflicts of interest to declare.
Acknowledgements
This research was supported by participants from the 50+ Registry of the Australasian Centre on Ageing at The University of Queensland. We thank Helen Seale and James Walsh from the Prince Charles Hospital for their assistance with subject recruitment. The study was funded by a Program Grant (ID631717) from the National Health and Medical Research Council (NHMRC) of Australia. PH is supported by a Senior Principal Research Fellowship (APP1002190) from the NHMRC. The study sponsors had no role
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