Respiratorymuscle
mechanicsatrestand
duringexercise
KINESIOLOGYOFBREATHING
Professor RikGosselink, PT, PhD
Faculty ofKinesiology and Rehabilitation Sciences
Department Rehabilitation Sciences
University Hospital Leuven
KULeuvenBelgium
Questions
● Chestwallmotion:ribsandabdomen
● Respiratorymuscles:
●
●
Inspiratoryprimaryandaccessorymuscles
Abdominalmuscles
● Respiratorymuscleinteractionduring
Exercise
● Respiratorymusclefatigue
● Dyspneaandrespiratorymuscles
+/- 6.5Million litersofairperyear
Thelungsarenotexpanded
becausetheyarefilledwithair,
but
theyarefilledwithairbecause
theyareexpanded
FranciscusSylviusdelaBoe
OperaMedica1681
CNS
SPINALCORD
RESPIRATORYMUSCLES
CHESTWALL
LUNGS
VENTILATION- PERFUSION
GASEXCHANGE
ACTOFRESPIRATORYMUSCLES
● RESPIRATION
● COUGH
● SPEECH
● TRUNKMOVEMENT/STABILIZATION
● DEFEACATION
EXPIRATION
INSPIRATION
RIBCAGE
BUCKETHANDLEMOVEMENT
LATERALRIBMOVEMENT
PUMPHANDLEMOVEMENT
VENTRALRIBMOVEMENT
RESPIRATORYMUSCLES
DIAPHRAGM
●
STERNO-COSTALPART
● CRURALPART
DIAPHRAGM
CONTRACTION
● INSERTIONALCOMPONENT
● APPOSITIONALCOMPONENT
● PLEURALPRESSURE
INSERTIONALCOMPONENT
PUNCTUM
FIXUM
PUNCTUM
MOBILUM
APPOSITIONAL
COMPONENT
FRC
TLC
INSERTIONAL
COMPONENT
APPOSTIONAL
COMPONENT
FUNCTIONAL
RESIDUALCAPACITY
TOTAL LUNGCAPACITY
PARALLELARRANGEMENT
F=F1+F2
1
2
PLEURAL
PRESSURE
Ppl
QUADRPLEGIA
Frownfelteretal.Principesandpracticeofcardiopulmonary
physicaltherapy.
RESPIRATORYMUSCLES
SCALENES
Primaryinspiratorymuscles
INTERCOSTALMUSCLES
● INTEROSSEUSINTERCOSTALS
● INTERCHONDRALINTERCOSTALS
‘PARASTERNALS’
ACCESSORYMUSCLES
● STERNOCLEIDOMASTOID
● PECTORALISMAJORandMINOR
● ABDOMINALMUSCLES
● TRIANGULARISSTERNI
● TRAPEZIUS
● PLATYSMA
ABDOMEN
and
ABDOMINALMUSCLES
Buckethandle
Respiratory muscles
during exercise
VE
(L.min-1)
MVV
VO2 (L.min-1)
Alivertietal.JApplPhysiol1997:83;1256
Alivertietal.JApplPhysiol1997:83;1256
Alivertietal.JApplPhysiol1997:83;1256
•
•
•
•
During exercise the diaphragm acts primarily as
a ‘flow‘ generator and not as ‘pressure’
generator
The length of the diaphragm reduces
significantly during exercise ventilation
The contraction of the abdominal muscles
during expiration supports the upward
movement (i.e. lengthening) of the diaphragm
The relaxation of the abdominal muscles
during inspiration helps to unload the
diaphragm allowing its high velocity of
shortening
Alivertietal.JApplPhysiol1997:83;1256
RESPIRATORYMUSCLEFATIGUE
WORKOFBREATHING
70
ESOPHAGEALPRESSURE
(%PImax)
60
COPD
50
40
30
..
Normals
..
20
10
0
0
10
.
20
30
40
VO2 (ml/min/kg)
O’Donnelletal.AmJRespirCritCareMed,155:109-115,1997.
CNSoutput
Respiratorydrive
Pump
Capacity
Respiratory
musclepump
Loadon
thepump
Ventilatory
Failure
Respiratory Oxygen Consumption
YOUNGNORMALSUBJECTS
2.5
Respiratory:2-10%
VO2 (l/min)
2.0
.
1.5
Non-respiratory
1.0
0.5
0
10 20 30 40 50 60 70
.
VE (l/min)
LevisonandCherniackJAP1968
DYSPNEA
and
RESPIRATORYMUSCLES
‘Effort’ tobreathandExertional Dyspnea
Borg Score
5
4
3
2
1
Borg ≈ Pes/PImax r=0.6, p<0.05
0
0
10
20
30
40
50
Pes (% PImax)
Modified from O’Donnell et al JAP 1998