Thoracoabdominal movement and breathing exercises: literature review

Abstract

The chest wall is composed of the rib cage and the abdominal compartments, which move in synchrony during the breathing act. This movement reflects the participation of the inspiratory muscles that change the pulmonary volumes. The technological evolution and the concept of muscular participation during the phases of the breathing cycle and the thoracic and abdominal movement behavior was modified. Nowadays, we are aware that it is possible to estimate pulmonary flowing volume through
thoracoabdominal displacement, which determines the respiratory pattern and the activity of different respiratory muscles. It is well established that, during breathing, subjects displaced predominantly the abdomen when in supine, and the thoracic cage when in upright position. Chest physiotherapy has a great variety of techniques that interfere in the ventilatory pump behavior. In particular, breathing exercises that modify the involvement of respiratory muscles, improve pulmonary ventilation. Breathing exercises studies that deal with diaphragmatic and intercostal exercises have been basically analyzed in three aspects: 1) normalization of the thoracoabdominal movement, 2) ventilation distribution, 3) modification of the respiratory pattern and gaseous exchange, which relieves dyspnea. In the 80's, Cuello introduced a new scheme of breathing exercises denominated "respiratory muscular pattern". He also studied the effects of these exercises in the ventilation distribution as well as their clinical results. Although, breathing exercises are widely used as a physiotherapeutic resource, they have been seldom studied. The study of the thoracoabdominal movement in association with breathing exercises as well as the investigation of the impact of these techniques in respiratory muscular action and pulmonary volumes generation may lead to a better understanding of chest physiotherapy.