title: Effect of volume-oriented versus flow-oriented incentive spirometry on chest wall volumes, inspiratory muscle activity, and thoracoabdominal synchrony in the elderly.
abstract: BACKGROUND
  Aging causes physiological and functional changes that impair pulmonary function. Incentive spirometry is widely used for lung expansion, but the effects of volume-oriented incentive spirometry (VIS) versus flow-oriented incentive spirometry (FIS) on chest wall volumes, inspiratory muscle activity, and thoracoabdominal synchrony in the elderly are poorly understood. We compared VIS and FIS in elderly subjects and healthy adult subjects.
  
  
  METHODS
  Sixteen elderly subjects (9 women, mean ± SD age 70.6 ± 3.9 y, mean ± SD body mass index 23.8 ± 2.5 kg/m(2)) and 16 healthy adults (8 women, mean ± age 25.9 ± 4.3 y, mean ± body mass index 23.6 ± 2.4 kg/m(2)) performed quiet breathing, VIS, and FIS in randomized sequence. Chest wall kinematics (via optoelectronic plethysmography) and inspiratory muscle activity (via surface electromyography) were assessed simultaneously. Synchrony between the superior thorax and abdominal motion was calculated (phase angle).
  
  
  RESULTS
  In the elderly subjects both types of incentive spirometry increased chest wall volumes similarly, whereas in the healthy adult subjects VIS increased the chest wall volume more than did FIS. FIS and VIS triggered similar lower thoracoabdominal synchrony in the elderly subjects, whereas in the healthy adults FIS induced lower synchrony than did VIS. FIS required more muscle activity in the elderly subjects to create an increase in chest wall volume.
  
  
  CONCLUSIONS
  Incentive spirometry performance is influenced by age, and the differences between elderly and healthy adults response should be considered in clinical practice.
authors: Department of Physical Therapy, School of Medicine, University of São Paulo, São Paulo, Brazil.
authors: Adriana C
authors: AC
authors: Lunardi
authors: Desiderio C
authors: DC
authors: Porras
authors: Renata Cc
authors: RC
authors: Barbosa
authors: Denise M
authors: DM
authors: Paisani
authors: Cibele C B
authors: CC
authors: Marques da Silva
authors: Clarice
authors: C
authors: Tanaka
authors: Celso R F
authors: CR
authors: Carvalho
mesh_terms: D000328:Adult; D000368:Aged; D001945:Breathing Exercises; D004576:Electromyography; D005260:Female; D006801:Humans; D008297:Male; D015656:Respiratory Mechanics / Q000502:physiology*; D012132:Respiratory Muscles / Q000502:physiology*; D013147:Spirometry / Q000379:methods*; D035441:Thoracic Wall; D055815:Young Adult
keywords: biomechanics; breathing exercises; chest wall; elderly; electromyography; incentive spirometry; lung volumes; physical therapy; respiratory mechanics