Updated Perspectives on the Role of Biomechanics in COPD: Considerations for the Clinician

Abstract

Patients with chronic obstructive pulmonary disease (COPD) demonstrate extra-pulmonary functional decline such as an increased prevalence of falls. Biomechanics offers insight into functional decline by examining mechanics of abnormal movement patterns. This review discusses biomechanics of functional outcomes, muscle mechanics, and breathing mechanics in patients with COPD as well as future directions and clinical perspectives. Patients with COPD demonstrate changes in their postural sway during quiet standing compared to controls, and these deficits are exacerbated when sensory information (eg, eyes closed) is manipulated. If standing balance is disrupted with a perturbation, patients with COPD are slower to return to baseline and their muscle activity is differential from controls. When walking, patients with COPD appear to adopt a gait pattern that may increase stability (eg, shorter and wider steps, decreased gait speed) in addition to altered gait variability. Biomechanical muscle mechanics (ie, tension, extensibility, elasticity, and irritability) alterations with COPD are not well documented, with relatively few articles investigating these properties. On the other hand, dyssynchronous motion of the abdomen and rib cage while breathing is well documented in patients with COPD. Newer biomechanical technologies have allowed for estimation of regional, compartmental, lung volumes during activity such as exercise, as well as respiratory muscle activation during breathing. Future directions of biomechanical analyses in COPD are trending toward wearable sensors, big data, and cloud computing. Each of these offers unique opportunities as well as challenges. Advanced analytics of sensor data can offer insight into the health of a system by quantifying complexity or fluctuations in patterns of movement, as healthy systems demonstrate flexibility and are thus adaptable to changing conditions. Biomechanics may offer clinical utility in prediction of 30-day readmissions, identifying disease severity, and patient monitoring. Biomechanics is complementary to other assessments, capturing what patients do, as well as their capability.

Analysis of emerging trends and hot spots in respiratory biomechanics from 2003 to 2022 based on CiteSpace

“…The exclusion criteria were ( Yentes et al, 2022 ): articles collected by hand and telephone ( Yuan et al, 2022 ); articles not officially published; ( Zang et al, 2022 ); the document type of letter, meeting abstract, editorial material, etc. ( Kamalabadi et al, 2022 ) repeated publications ( Long et al, 2021 ); unrelated articles.…”

“…The version used in this research was 6.1.R6 (64-bit). We used CiteSpace with the following parameters: time slicing (2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016)(2017)(2018)(2019)(2020)(2021)(2022), years per slice (Yentes et al, 2022), term source (all selections), node type (one at a time), selection criteria (top 50 objects), pruning (pruning sliced networks), and visualization (cluster view-static). In this study, CiteSpace provided analysis on researching journal/cited journals, country, institution, author/cited authors, references, keywords and research trends.…”

“…Respiratory biomechanics is the studies of the forces acting on the human respiratory system and the responses produced by breathing ( Yentes et al, 2022 ). The respiratory system itself is mechanical, therefore it is best to use biomechanical research methods to study respiratory movements.…”

Updated Perspectives on the Role of Biomechanics in COPD: Considerations for the Clinician [Letter]

“…I read with interest the article by Yentes et al 1 The text emphasizes the importance of the extrapulmonary component in chronic obstructive pulmonary disease (COPD), and directs the clinician’s interest towards biomechanics (“forces that act upon a body and the reactions produced”). 1 Skeletal musculature in COPD patients adapts with phenotypic, morphological and functional non-physiological changes, which adaptations do not always reflect the speed of pulmonary changes, or do not always correlate with the severity of the disease. 1 Skeletal muscle mass reduces volumes (atrophy), and there is a shift in contractile fibers from an aerobic to anaerobic metabolism, where white or type II fibers increase, with parallel decrease in red or type I fibers.…”

“… 1 Skeletal musculature in COPD patients adapts with phenotypic, morphological and functional non-physiological changes, which adaptations do not always reflect the speed of pulmonary changes, or do not always correlate with the severity of the disease. 1 Skeletal muscle mass reduces volumes (atrophy), and there is a shift in contractile fibers from an aerobic to anaerobic metabolism, where white or type II fibers increase, with parallel decrease in red or type I fibers. 2 Although type II fibers have a greater ability to increase volume (hypertrophy) and a greater ability to express contractile force than type I fibers, such adaptation in COPD does not occur.…”