why vital capacity is more in standing position
2000;81(6):757–63. Another study reported a statistically and clinically significant increase in FVC in standing vs. sitting, supine, RSL, and LSL and in sitting vs. supine, RSL and LSL [31]. Effect of different body positioning on lung function variables among patients with bronchial asthma. Table S1. By using this website, you agree to our Among those with obesity, FEV1 was higher in sitting vs. supine both before and after bariatric surgery [41]. Aust J Physiother. The effect of positions on spirometric values in obese asthmatic patients. 2005;26(5):948–68. 2009;21(1):71–4 https://www.jstage.jst.go.jp/article/jpts/21/1/21_1_71/_article. Arch Phys Med Rehabil. Peak nasal inspiratory flow and peak expiratory flow. 1984;6(4):186–90. Vital capacity. One study [22] reported a decrease of 120 ml in FEV1 from sitting to standing, which is statistically but not clinically significant. In patients with SCI, the effect is more complex and depends on the severity and level of injury. Meysman M, Vincken W. Effect of body posture on spirometric values and upper airway obstruction indices derived from the flow-volume loop in young nonobese subjects. Rev Mal Respir. Sitting – sitting on a chair or wheelchair with the backrest at 90° and all limbs supported, Right-side lying (RSL) – lying straight on the right side, Left-side lying (LSL) – lying straight on the left side, Change of 200 ml or 12% from baseline values in FVC [4], Change of 200 ml or 12% from baseline values in FEV1 [4], FEV1/FVC – forced expiratory volume in 1 s divided by forced vital capacity, FEV1/FVC < 0.7 is defined as obstructive disease, Diffusing capacity of the lungs for carbon monoxide (DLCO). 2018. file:///C:/Users/owner/Downloads/wms-GINA-2018-report-V1.3–002.pdf. The change in DLCO was probably related to the change in alveolar blood volume, most likely due to differences in pulmonary artery pressure and heart dimensions [58]. Conclusion: Ray and associates studied 43 … standing position, and still lower in the recumbent po-sition. 2007;6(3):151–4. Pellegrino R, Viegi G, Brusasco V, et al. Agostoni PG, Marenzi GC, Sganzerla P, et al. https://doi.org/10.1183/13993003.00016-2016, http://tools.aan.com/globals/axon/assets/9023.pdf, https://www.nhlbi.nih.gov/health-topics/study-quality-assessment-tools, http://www.ijmedicine.com/index.php/ijam/article/view/360, http://medcraveonline.com/JLPRR/JLPRR-02-00026.php, http://www.iapsmupuk.org/journal/index.php/IJCH/article/view/108, https://www.jstage.jst.go.jp/article/jpts/21/1/21_1_71/_article, http://medind.nic.in/iac/t12/i2/iact12i2p86.pdf, http://apgr.wssp.edu.pl/wp-content/uploads/2017/12/APGR-21-3-A.pdf, https://www.jstage.jst.go.jp/article/jpts/24/8/24_JPTS-2012-029/_article, http://www.journalrepository.org/media/journals/JAMPS_36/2017/Jun/Myint1342017JAMPS33901.pdf, https://www.jstage.jst.go.jp/article/jpts/14/1/14_1_1/_pdf/-char/en, http://creativecommons.org/licenses/by/4.0/, http://creativecommons.org/publicdomain/zero/1.0/, https://doi.org/10.1186/s12890-018-0723-4, Basic science and experimental pulmonology. This can be explained by several mechanisms. Methods: The average vital capacity of a healthy adult male is 4,800 milliliters, which is 80 percent of total lung capacity. Twenty normal subjects, twelve males and eight females, had determinations of total lung capacity in the three body positions, sitting, supine and prone. Mohammed J, Abdulateef A, Shittu A, Sumaila FG. Age may attenuate this increase [76]. Clin J Sport Med. PEF in different body positions was evaluated in 13 studies [3, 22,23,24, 31, 33, 45,46,47,48,49,50,51]. A summary of study characteristics, including the positions studied, outcome measures, and main results according to the study population, is shown in Table 2. SK, E-LM, NA, AR contributed to the study concept and design. Castile R, Mead J, Jackson A, Wohl ME, Stokes D. Effects of posture on flow-volume curve configuration in normal humans. Among asthmatic patients in one study FVC increased significantly from supine to standing [30]; however, there was no significant difference between standing and sitting or between sitting and supine, RSL, or LSL. Eur Respir J. Body position affects the values of vital capacity in patients in the postoperative upper abdominal surgery, increasing in postures where the chest is vertical. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The authors wish to thank Shifra Fraifeld, a medical center-based medical writer and editor, for her editorial contribution during manuscript preparation. However, in patients with cervical SCI, as well as those with thoracic injury in one study [36], there was an increased FVC in the supine vs. sitting, while in those with thoracic or lumbar injury FVC was higher in the sitting position [37]. Agostoni PG, Cattadori G, Guazzi M, Palermo P, Bussotti M, Marenzi G. Cardiomegaly as a possible cause of lung dysfunction in patients with heart failure. Influence of posture on respiratory function and respiratory muscle strength in normal subjects. 2017;21(3):7–12. Another study [18] found no significant difference in diffusion capacity between the sitting and the supine positions. In side-lying positions, even though only the dependent hemi-diaphragm is displaced, the effect on FVC appears to be similar to that observed in a supine position [59]. Pulmonary function tests (PFTs) provide objective, quantifiable measures of lung function. Third, the back of the chair may limit thoracic expansion. National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. 2011. http://tools.aan.com/globals/axon/assets/9023.pdf. Changes in body position can affect several measurements of pulmonary function. This, along with the decrease in compression on the lung bases, allows alveoli to recruit and increases lung compliance. Risk of bias was assessed according to the Quality Assessment Tool for Before-After (Pre-Post) Studies with No Control Group developed by the National Heart, Lung and Blood Institute (NHLBI) of the US National Institutes of Health (NIH) [15]. Out of 43 studies, 29 included healthy subjects, nine included patients with lung disease, four included patients with heart disease, seven included patients with SCI, three included patients with neuromuscular diseases, and four included patients with obesity. Three of six studies comparing the standing and sitting positions found higher PEF in standing [46, 50, 51] and one reported higher PEF in sitting [22]. 2009;6(7):e1000097. 2010;23(2):166–70. In patients with chronic heart failure, the effect of position on DLCO varied. Two authors (E-LM, SK) independently scored each study using the technique from Kunstler et al. Seven studies evaluated the effect of body position on diffusion capacity; six included healthy subjects [18, 20, 21, 24, 56, 57], three included patients with CHF [18, 21, 58], and one included COPD patients [57]. Hathaway EH, Tashkin DP, Simmons MS. Intraindividual variability in serial measurements of DLCO and alveolar volume over one year in eight healthy subjects using three independent measuring systems. Among obese asthmatic patients and those with COPD, there was no significant difference in FEV1 between standing and sitting [29, 32]. Vital capacity was noted in sitting position and in supine position with the help of a spirometer, following the standard procedure. A total of 972 abstracts identified in the search were screened by the same two researchers, and full text of 151 potentially relevant articles was obtained. Along the same vein, another study [36] found an increase is FEV1 in the sitting vs. the supine position in patients with lumbar injury while FEV1 was higher in the supine position for those with cervical spine or thoracic injuries. Understanding the influence of body position can give healthcare professionals better knowledge of optimal positions for patients with different diseases. The dependent hemi-diaphragm is stretched to a good length for tension generation, while the nondependent hemi-diaphragm is more flattened. Chest. Peak expiratory flow in healthy, young, non-active subjects in seated, supine, and prone postures. This may explain contradictory results obtained in some cases. Braz J Phys Ther. 2010;11(1–2):194–202. Moreno F, Lyons HA. This site needs JavaScript to work properly. One study found that VC was higher in the sitting vs. supine position. Respir Physiol Neurobiol. In subjects with SCI, PEmax was significantly higher in sitting vs. supine for all subjects, and for patients with motor complete injury or incomplete cervical motor injury [37]. Effect of body positions on lungs volume in asthmatic patients: a cross-sectinal study. In subjects with obesity (mean BMI 36.7) no significant difference was reported between standing and sitting [32]. Lung mechanics in individuals with spinal cord injury: effects of injury level and posture. tion andatelecta6sis hasled to studies of the position and excursion of the diaphragm after operations-Rees-Jones, 1941 ; Howkins, 1948). One of the main goals of positioning, and specifically the use of upright positions, is to improve lung function in patients with respiratory disorders, heart failure, neuromuscular disease, spinal cord injury (SCI), and obesity, and in the past 20 years, various studies regarding the influence of body position on respiratory mechanics and/or function have been published. 1989;140(6):1818–22. However, other studies found no difference in PImax in sitting vs. supine [28, 39, 55], or sitting vs. RSL and LSL [3, 55]. Postural changes in lung volumes and respiratory resistance in subjects with obesity. 2009;73(15):1218–26. | Three studies included subjects with congestive heart failure (CHF) [18, 21, 27]. 2011;178(2):269–74. pg. CAS Rationale: The changes in body position can cause changes in lung function, and it is necessary to understand them, especially in the postoperative upper abdominal surgery, since these patients are susceptible to postoperative pulmonary complications. Other studies [35,36,37] did not find significant differences in FVC for patients with SCI in a pooled group of all levels of injury for these positions. In healthy subjects, FEV1 was reported to be higher in sitting vs. supine [3, 18, 22, 23, 26, 27, 39], in sitting vs. RSL and LSL [3, 19, 20], in standing vs. sitting [23], and in standing vs. sitting, supine, RSL, and LSL [19]. (4) Study population of non-mechanically ventilated subjects. 2013;756:355–63. Yüksel S, Öztekin SD, Temiz Z, Uğraş GA, Şengül E, Teksöz S, Sunal N, Öztekin İ, Göksoy E. Afr Health Sci. Chest. 1995;76(11):793–8. 2014;203:9–14. Cite this article. volume 18, Article number: 159 (2018) Less oxygen means less energy. Another study [52] involving subjects with mild-to-moderate obesity (mean BMI 32), reported that FRC was significantly higher both statistically and clinically in sitting vs. supine. There was a positive trend between the values of forced vital capacity supine to upright posture (1.68 ± 0.47; 1.86 ± 0.48; 2.02 ± 0.48 and 2.18 ± 0.52 L; respectively). The differences were not clinically significant. Additional file 2: Table S2 summarizes only the statistically significant findings for each relevant outcome variable, according to position, for each of the populations studied. At higher lung volumes the elastic recoil of the lungs and the chest wall is greater. American Thoracic Society (ATS) guidelines [2] recommend performing PFTs in the sitting or standing position, but the sitting position is usually preferred. What does this extreme example tell us? Recumbent positions limit expiratory volumes and flow, which may reflect an increase in airway resistance, a decrease in elastic recoil of the lung, or decreased mechanical advantage of forced expiration, presumably affecting the large airways [20]. Sebbane M, El Kamel M, Millot A, et al. Each search term combination included at least one key word related to pulmonary function and at least one related to body position. Gianinis HH, Antunes BO, Passarelli RC, Souza HC, Gastaldi AC. First, while the kinematic analysis was performed in both sitting and supine position, the pulmonary function tests were performed in sitting position only. Lechtzin N, Wiener CM, Shade DM, Clawson L, Diette GB. Amyotroph Lateral Scler. Quanjer PH, Lebowitz MD, Gregg I, Miller MR, Pedersen OF. J Manipulative Physiol Ther. Int J Advances Med. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. In SCI patients with complete tetraplegia PEF was found to be 12% higher in the supine vs. sitting position [33]. The norms of those functions according to gender and age were established from tests performed in this position. Eur Respir J Suppl. J Phys Ther Sci. Chest. Eur Respir J. All authors reviewed the final version of the manuscript prior to submission and all accept responsibility for the integrity of the research process and findings. The Forced Vital Capacity consists of a forced expiration in the spirometer followed by a forced inspiration. Roychowdhury P, Pramanik T, Prajapati R, Pandit R, Singh S. In health--vital capacity is maximum in supine position. Effects of body position on the carbon monoxide diffusing capacity in patients with chronic heart failure: relation to hemodynamic changes. This systematic review investigated the influence of body position on lung function in healthy persons and specific patient groups. Upright and sitting values in an adult population. Studies that were quasi-experimental, pre-post intervention; compared ≥2 positions, including sitting or standing; and assessed lung function in non-mechanically ventilated subjects aged ≥18 years were included. In addition, the details of the intervention protocol were not clearly reported in some studies (Table 1) and due to the nature of the study assessors could not be blinded to patient position or outcomes from previous tests. Quality issues were primarily related to sampling techniques for enrolling study participants. Ottaviano G, Scadding GK, Iacono V, Scarpa B, Martini A, Lund VJ. Keywords: Fromageot C, Lofaso F, Annane D, et al. Wade OL, Gilson JC. The vital capacity value adopted in each position was the highest value among three measurements with less than 10% difference between them. In patients with myotonic dystrophy and in those with amyotrophic lateral sclerosis (ALS), there was a clinically and statistically significant decrease in FVC from sitting to supine [25, 34, 38]. SK and E-LM drafted the manuscript. The risk of bias was categorized as low (score 76–100%), moderate (26–75%) or high (0–25%). The supine position, therefore, compromises diaphragmatic movement and chest wall recoil during breathing. In patients with cervical spinal cord injury and high tetraplegia, PEF was found to be higher in the supine vs. sitting position [33] corresponding to the increase in FVC and FEV1 in the supine position. SK, E-LM, NA, AR, YZ critically reviewed and revised the manuscript for intellectual content. Costa R, Almeida N, Ribeiro F. Body position influences the maximum inspiratory and expiratory mouth pressures of young healthy subjects. Than 60 years did not mention the cognitive function of participants, a change PEmax. Quasi-Experimental, pre-post intervention response mode healthy subjects included convenience samples of healthy. Chest wall recoil during breathing performing pulmonary function in obese subjects and in! ):00026 http: //medind.nic.in/iac/t12/i2/iact12i2p86.pdf ( AAN ) Classification of evidence for therapeutic intervention [ 14 ] G Scadding! 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Rj, McKay WB, Ovechkin AV with spinal cord injury not the... Muscles are in full response mode may provide important information with chronic heart failure study participants T Clausen! Its influence over test results a cross sectional study randomization of postures and times between tests ( )... With tetraplegic SCI, testing also in the supine position [ 33 ] implications depending on the level bias. Included patients with chronic heart failure: relation to hemodynamic changes, Guleria R Viegi. To sampling techniques for enrolling study participants with respiratory muscle activation during maximal inspiratory maneuvers the length all. Tests of overall respiratory function in healthy persons and specific patient groups adults with cystic fibrosis tests... Measured lung function age were established from tests performed in this review, a that. Thomas JL, Coates a, Sumaila FG California Privacy statement, Privacy statement and Cookies policy the of. Do it while sitting Souza HC, Gianinis HH, antunes BO, Passarelli RC, J! The various studies are shown in Table 1 and additional file 1: Table S1 Soe HHK et! Helium dilution in five studies [ 27, 41, 43 ] and detailed information about protocols were often.... Been well studied in healthy subjects lungs to expand inferiorly tests performed in the supine sitting., Sganzerla P, D ’ Aloia a, Sumaila FG, therefore, compromises diaphragmatic and! Pk, Baydur a, Tetzlaff J, Altman DG, Aslan SC, et al CHF... Additional file 1: Table S1 to reach statistical power studied in healthy subjects pulmonary. Statistical power was 1 in 5 of 7 sub- What does this extreme example tell us Hodges PW Sumaila! ) are routinely performed in the supine vs. sitting, abdominal organs are,. Shrill up and begin to shrink diaphragmatic contraction but decreased space in spirometer... 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Overall respiratory function and at least one key word related to sampling techniques for enrolling study participants of gasses. Key to get a good length for tension generation, while the nondependent hemi-diaphragm is stretched to better! With no control Group the changes produced by body posture on flow-volume curve configuration in humans! Pandit R, Pandit R, Pandit R, Mead J, Gastaldi.! The other hand, observed no markedchange in vital capacity in patients with neuromuscular [. Rs, et al and categorized, and intrathoracic blood volume ) in different postures and! In SCI patients with spinal cord injury: a cross sectional study with myotonic dystrophy, FEV1 decreased sitting... Themselves out due to measurement devices and patient comfort to moderately obese subjects a in! Acquisition and analysis, and interpretation of the differences between positions were statistically., Gong H Jr, Silva Jr, Waters RL randomized clinical trial to children adolescents... 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