CHEST WALL AND ABDOMINAL MOTION DURING EXERCISE IN PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY-DISEASE

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Abstract
To evaluate the role of coordination between the chest wall and abdomen during exercise in patients with chronic obstructive pulmonary disease (COPD), 40 patients with COPD and 6 control subjects with normal lung function underwent a progressive exercise stress test on a treadmill ergometer. The normal subjects exhibited symmetrical motion between the chest wall and abdomen. Three separate patient groups were differentiated by differences in abdominal response to increasing exercise. Group 1 was similar to normal or showed an early abdominal peak. Group 2 had a prolonged outward motion of the abdomen, and group 3 had an inward motion of the abdomen during inspiration. Resting pulmonary function (1s forced expiratory volume, vital capacity, lung diffusing capacity, residual volume/total lung capacity and exercise response (duration, O2 saturation and maximal .ovrhdot.VO2 [O2 uptake]) were progressively more abnormal from group 1 through group 3. The addition of O2 to group 3 had no effect on the pattern observed. When 2 patients with a group 3 response were re-exercised, flexed 45.degree. at the waist, they no longer were completely paradoxical, they were less dyspneic, and they could walk farther. Chest-abdominal coordination is related to the underlying pulmonary abnormality. The paradoxical pattern seen in some patients (group 3) is associated with very severe exercise limitation.