The association between FVC and body position in healthy subjects was investigated in 13 studies [3, 17,18,19,20,21,22,23,24,25,26,27,28]. 1984;6(4):186–90. The position on orthostasis showed higher values of vital capacity regarding standing (mean change: 0.15 ± 0.03 L; p = 0.001), the supine to 45 (average difference: 0.32 ± 0.04 L; p = 0.001) and 0° (0.50 ± 0.05 L; p = 0.001). The effect of body position on vital capacity was evaluated in six studies of healthy subjects [21, 24, 28, 39, 43, 44]. In patients with spinal cord injury, VC was higher in the supine vs. sitting position [40]. Prevalence of diaphragmatic muscle weakness and dyspnoea in Graves’ disease and their reversibility with carbimazole therapy. Body position affects the values of vital capacity in patients in the postoperative upper abdominal surgery, increasing in postures where the chest is vertical. 2002;14(1):1–5. Iran J Allergy Asthma Immunol. the standard procedure. Elkins MR, Alison JA, Bye PT. Accessed 29 May 2018. Level of evidence was assessed according to the American Academy of Neurology (AAN) Classification of Evidence for therapeutic intervention [14]. Melam GR, Buragadda S, Alhusaini A, Alghamdi MA, Alghamdi MS, Kaushal P. Effect of different positions on FVC and FEV1 measurements of asthmatic patients. In addition, the length of all other inspiratory muscles may become less optimal in supine position [75]. Wanger J, Clausen JL, Coates A, et al. Seven studies compared FEV1/FVC for different body positions in healthy subjects [18, 19, 23, 24, 27, 28, 42]. Respir Care. In most studies no difference was reported between sitting and supine [21, 24, 28, 43] or between sitting and RSL or LSL [21]. (2004), reported that slumped posture significantly reduced the lung capacity, compared with that … PubMed Google Scholar. Chest measurements were made by Livingstone [1928] who used radio- logical methods; he demonstrated that the capacity ofthe chest is least when Int J Advances Med. 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). Agostoni PG, Marenzi GC, Sganzerla P, et al. Use of respiratory function tests to predict survival in amyotrophic lateral sclerosis. 1951;6(2):103–26. Pellegrino R, Viegi G, Brusasco V, et al. Respiration. Three studies included subjects with congestive heart failure (CHF) [18, 21, 27]. Smoking affects lung capacity because your lungs will shrill up and begin to shrink. Arch Phys Med Rehabil. Changes in body position can affect several measurements of pulmonary function. © 2021 BioMed Central Ltd unless otherwise stated. Forty-three studies met inclusion criteria. 2020 Mar;20(1):488-497. doi: 10.4314/ahs.v20i1.55. The body is most able to expand in every direction when standing because the muscles are in full response mode. 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]. The effect of positions on spirometric values in obese asthmatic patients. Effect of weight loss on postural changes in pulmonary function in obese dubjects: a longitudinal study. 1992;102(1):139–42. Decreased FVC in more recumbent positions may reflect both increased thoracic blood volume due to gravitational facilitation of venous return, which is more important in patients with heart failure, as well as cephalic displacement of the diaphragm due to abdominal pressure in the recumbent positions, which is more important in obese subjects [59]. However, another study [44] found that VC was higher in the supine vs. sitting position, but only in females. Tsubaki A, Deguchi S, Yoneda Y. 1980;61(6):347–56. Among patients with obesity the sitting FRC was less than in healthy subjects but there was no further decrease in the supine position [43]. The protocols and level of bias in the various studies are shown in Table 1 and Additional file 1: Table S1. 2001;57(2):357–9. PLoS Med. Vital capacity is also proportional to the surface area of a person. The dependent hemi-diaphragm is stretched to a good length for tension generation, while the nondependent hemi-diaphragm is more flattened. 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). Rhinology. Another study [18] found no significant difference in diffusion capacity between the sitting and the supine positions. Three studies evaluated patients with neuromuscular diseases [25, 34, 38]. J Appl Physiol Respir Environ Exerc Physiol. There are a few limitations to this review. In contrast, diffusion capacity, as assessed by DLCO, increases in the supine position in healthy subjects while the effect in CHF patients is thought to depend upon pulmonary circulation pressure. BMC Pulm Med 18, 159 (2018). Chest. Most studies in this systematic review of 43 papers evaluating the effect of body position on pulmonary function found that pulmonary function improved with more erect posture in both healthy subjects and those with lung disease, heart disease, neuromuscular diseases, and obesity. Accessed 29 May 2018. The effects of different degrees of head-of-bed elevation on the respiratory pattern and drainage following thyroidectomy: a randomized controlled trial. 2018. file:///C:/Users/owner/Downloads/wms-GINA-2018-report-V1.3–002.pdf. Peak expiratory flow in bed? Lechtzin N, Wiener CM, Shade DM, Clawson L, Diette GB. In healthy subjects, PImax was improved in sitting vs. supine in two studies [3, 54]. 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 differences were not clinically significant. Thus, in the majority of studies the more upright position was associated with increased FVC. Arch Phys Med Rehabil. In side-lying positions, the heart weighs on one lung, compressing both airways and lung parenchyma, reducing alveolar blood volume, and causing ventilation/ perfusion mismatch. (DOCX 63 kb), Table S2. Chest. Cookies policy. 2010;51(3):392–7. To assess the vital capacity in the supine position (head at 0° and 45°), sitting and standing positions in patients in the postoperative upper abdominal surgery. The effect of body position on maximal expiratory pressure and flow. Br J Sports Med. First, while the kinematic analysis was performed in both sitting and supine position, the pulmonary function tests were performed in sitting position only. This might be related to reduced FVC and alveolar damage in these patients. Mohammed J, Abdulateef A, Shittu A, Sumaila FG. Ventilatory changes following head-up tilt and standing in healthy subjects. 3 d) What is the relationship between age and standing vital capacity? In these last 10 men, vital capacity was measured with the subjects standing; otherwise, measurements were made in the seated position and the men were not fasting. http://www.iapsmupuk.org/journal/index.php/IJCH/article/view/108. Lung Volumes and Capacities in Pregnancy In pregnancy, as the uterus enlarges and the abdomen gets distended, the diaphragm is pushed upwards. FVC is thus an important clinical tool for assessment of diaphragmatic weakness in patients with neuromuscular diseases [64]. Graham BL, Brusasco V, Burgos F, et al. Naturally, in supine posture the scope of diaphragmatic movements increased and as a … Stewart IB, Potts JE, McKenzie DC, Coutts KD. Positioning plays an important role in maximizing respiratory function when treating patients with various problems and diseases and it is important to know the implications of each position on the respiratory system of a specific patient. Phys Ther. Manning F, Dean E, Ross J, Abboud RT. Eur J Endocrinol. This may be related to changes in lung volumes with positions. Body position influences the results of PFTs, but the optimal position and magnitude of the benefit varies between study populations. Behrakis PK, Baydur A, Jaeger MJ, Milic-Emili J. N Engl J Med. Among healthy subjects, FRC was higher in standing [53] and in sitting [27, 43] vs. supine, with the differences reaching statistical and clinical significance. Effect of body position on maximal expiratory pressure and flow in adults with cystic fibrosis. 2009;77(1):51–7. Accessed 29 May 2018. In patients with SCI, the effect is more complex and depends on the severity and level of injury. Ottaviano G, Scadding GK, Iacono V, Scarpa B, Martini A, Lund VJ. PubMed  Postural changes in lung volumes and respiratory resistance in subjects with obesity. Gronseth GS, Woodroffe LM, Getchuis TSD. Compared with the standing position, the effect of gravity on abdominal viscera is less at sitting position and least if lying supine . Badr C, Elkins MR, Ellis ER. Standing helps because your lungs are expanding when you stand but not when you sit. Six studies investigated the association between body position and PEmax in healthy subjects [3, 28, 39, 46, 54, 55]. Schmidt EP, Drachman DB, Wiener CM, Clawson L, Kimball R, Lechtzin N. Pulmonary predictors of survival in amyotrophic lateral sclerosis: use in clinical trial design. Effect of supine posture on airway blood flow and pulmonary function in stable heart failure. 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. Respir Care. In subjects with chronic SCI, no significant change was seen in PImax between sitting and supine, with the exception of a subgroup of patients with complete thoracic motor paresis where there was statistically and clinically significant improvement in sitting [37]. Rationale: Hosenpud JD, Stibolt TA, Atwal K, Shelley D. Abnormal pulmonary function specifically related to congestive heart failure: comparison of patients before and after cardiac transplantation. De S. Comparison of spirometric values in sitting versus standing position among patients with obstructive lung function. There was a clinical and statistically significant increase in FVC in sitting vs. supine positions [3, 18, 22,23,24,25,26,27], in sitting vs. RSL and LSL [3, 21], standing vs. supine [19, 23], and standing vs. RSL and LSL [19]. Miccinilli S, Morrone M, Bastianini F, et al. As for the healthy person, the best vital capacity would probably come from either laying down or standing. statement and However, other studies found no difference in PImax in sitting vs. supine [28, 39, 55], or sitting vs. RSL and LSL [3, 55]. (6) English language. 2005;26(1):153–61. Respir Physiol Neurobiol. The effect of sitting, standing and supine position on ventilatory functions has not been well studied in healthy subjects. Arch Phys Med Rehabil. Respir Care. Among obese asthmatic patients [32], and among patients with chronic obstructive pulmonary disease (COPD) [29], no difference was found in FVC between standing and sitting. 2014;193:43–51. Clinical practice guideline process manual. 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]. A comparison of 3 positions. 2005;95(5–6):409–17. 2005;98(2):512–7. In lung disease, particularly restrictive lung disease, the amount of air the lungs can hold can be dramatically increased, this causing vital capacity … One study [22] reported a decrease of 120 ml in FEV1 from sitting to standing, which is statistically but not clinically significant. Other factors that may contribute to lower FVC values in side-lying positions include increased airway resistance and decreased lung compliance secondary to anatomical differences between the left and right lungs, as well as shifting of the mediastinal structures [20]. Benedik PS, Baun MM, Keus L, et al. PubMed  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. The average vital capacity of a healthy adult male is 4,800 milliliters, which is 80 percent of total lung capacity. 2016;54(2):160–3. 2018;28(3):304–15. One study [39] found that VC was higher in the sitting vs. supine position. Fugl-Meyer AR, Grimby G. Respiration in tetraplegia and in hemiplegia: a review. One study found that VC was higher in the sitting vs. supine position. 2015 May-Jun;65(3):217-21. doi: 10.1016/j.bjan.2014.06.001. Chest. 2010;23(2):166–70. In patients with CHF, different patterns of the effect of posture on DLCO were observed [58]. Other studies found no difference in PEmax between sitting and supine [28, 39], or between sitting, supine, RSL, and LSL [3, 55]. However, we did not find a systematic review that integrates findings from studies involving non-mechanically ventilated adults to derive clinical implications for respiratory care and pulmonary function test (PFT) execution. The change in PEmax influences PEF [46]. Peces-Barba G, Rodriguez-Nieto MJ, Verbanck S, Paiva M, Gonzalez-Mangado N. Lower pulmonary diffusing capacity in the prone vs. supine posture. Scand J Rehabil Med. While lying, vital capacity is low and more while sitting. 2017 ERS/ATS standards for single-breath carbon monoxide uptake in the lung. Accessed 29 May 2018. Lung Pulm Resp Res. 1). All studies used non-random sampling. 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. This site needs JavaScript to work properly. J Physical Therapy Sci. Two authors (E-LM, SK) independently scored each study using the technique from Kunstler et al. All studies provide Class III level of evidence. Effects of posture on postoperative pulmonary function. Am Rev Respir Dis. Objective: In patients with neuromuscular disorders, performing PFTs in the supine position may help to assess diaphragmatic function. Goswami R, Guleria R, Gupta AK, et al. We aimed to systematically review studies that evaluated the effect of body position on lung function in healthy subjects and non-mechanically ventilated patients with lung disease, heart disease, SCI, neuromuscular disease, and obesity. Terzano C, Conti V, Petroianni A, Ceccarelli D, De Vito C, Villari P. Effect of postural variations on carbon monoxide diffusing capacity in healthy subjects and patients with chronic obstructive pulmonary disease. 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]. We recommend the supine position should be considered in addition to sitting for PFTs in patients with SCI and neuromuscular disease. 2005;40(5):385–91. Although these are not interventional studies, strictly speaking, we have chosen to assess them as “before and after intervention,” wherein the posture/position change is the maneuver of interest. Eur Respir J. These factors lead to decreased PEmax and PEF in the supine position [3]. Wilson [1927], on the other hand, observed no markedchange in vital capacity in different postures. In COPD patients, PEmax was higher in standing or sitting vs. supine or RSL [46], and was higher in standing and sitting vs. RSL in patients with cystic fibrosis [47]. Each search term combination included at least one key word related to pulmonary function and at least one related to body position. Two studies that evaluated RV using helium dilution in healthy subjects [43] and those with obesity [41, 43] found no statistically significant difference between sitting and supine. J Appl Physiol (1985). 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. Nine studies that compared standing or sitting positions vs. supine or RSL and LSL found higher PEF in standing and sitting [3, 22,23,24, 31, 45,46,47,48]. Sebbane M, El Kamel M, Millot A, et al. Among subjects with asthma, CHF, and obesity no statistically significant difference in FEV1/FVC was found between the different body postures [18, 27, 32, 42]. Int Rehabil Med. Methods: 2017;13(4):1–6 http://www.journalrepository.org/media/journals/JAMPS_36/2017/Jun/Myint1342017JAMPS33901.pdf. 2014. https://www.nhlbi.nih.gov/health-topics/study-quality-assessment-tools. Another group [37] reported no significant change in FEV1 between the sitting and supine positions for a pooled group of patients with SCI, but in the subgroup of patients with incomplete motor injury and in those with incomplete thoracic motor injury there was a decrease in the supine position. Google Scholar. Physiother Theory Pract. Terson de Paleville DG, Sayenko DG, Aslan SC, Folz RJ, McKay WB, Ovechkin AV. Preparation. J Phys Ther Sci. The year 1998 was chosen as the beginning point due to the publication of the seminal study by Meysman and Vincken [3]. Determinations of vital capacity only were done on 37 additional men, including 10 professional basket­ ball players. Wallace JL, George CM, Tolley EA, et al. PEF, PEmax, and PImax were found to increase in upright positions in healthy subjects [3, 23, 24, 46, 48, 50, 51] and in those with lung diseases [31, 46, 47]. Interpretative strategies for lung function tests. 2009;54(3):334–9. Effects of dorsal and lateral decubitus on peak expiratory flow in healthy subjects. Peak nasal inspiratory flow and peak expiratory flow. Naitoh S, Tomita K, Sakai K, Yamasaki A, Kawasaki Y, Shimizu E. The effect of body position on pulmonary function, chest wall motion, and discomfort in young healthy participants. Springer Nature. 2015;2(3):250–4 http://www.ijmedicine.com/index.php/ijam/article/view/360. FRC was reported to increase in upright positions in healthy subjects [27, 43, 53] and in patients with mild-to-moderate obesity [41, 52]. In several studies, FEV1/FVC was reported to be higher in sitting vs. supine [23, 28], in sitting vs. LSL [19], and in standing vs. supine, RSL, and LSL [19]; however, FEV1/FVC was > 70% in all body positions so the difference was not clinically significant. 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. Pulmonary function tests (PFTs) are routinely performed in the upright position due to measurement devices and patient comfort. 2005;26(5):948–68. Quite simply, the more restrictions you place on your breathing, the harder it becomes. In female, vital capacity is less by 20 to 25 percent. Huldtgren AC, Fugl-Meyer AR, Jonasson E, Bake B. Ventilatory dysfunction and respiratory rehabilitation in post-traumatic quadriplegia. The vital capacity value adopted in each position was the highest value among three measurements with less than 10% difference between them. Conclusion: Chen et al 1 found that the vital capacity of an able-bodied subject was enhanced in the standing posture, which Druz and Sharp 21 attributed to an increase in the activation of the ribcage inspiratory muscles and the diaphragm in the upright posture. 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. Side-lying was reported to reduce DLCO in comparison to sitting in the third study [21]. However, among patients with CHF, no difference in FRC between sitting and supine was reported [27]. In addition, the expiratory muscles are at a more optimal region of the length-tension curve and thus are capable of generating higher intrathoracic pressure, potentially generating higher expiratory pressures and pushing air through narrow airways at high speed, which results in higher PEmax, PEF, and FEV1. Articles were included if they met the following criteria: (1) Quasi-experimental, pre-post intervention. Aust J Physiother. 2012;24(8):655–7 https://www.jstage.jst.go.jp/article/jpts/24/8/24_JPTS-2012-029/_article. 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]. POSTURE ANDALVEOLAR GAS TENSIONS 5.5%in the recumbent position. Background: Spirometry may be done either in sitting or standing position. 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]. (5) Participants aged ≥18 years. In health--vital capacity is maximum in supine position. In another study among obese patients, there was no difference in FEV1 between standing and sitting [32]. However, the difference in sitting vs. supine was not significant among patients with obesity (mean BMI 44–45) [41, 43] or CHF [27], and was higher in sitting vs. supine in patients after bariatric surgery (mean BMI 31) [41]. Yap JC, Moore DM, Cleland JG, Pride NB. Another study in asthmatic patients reported FEV1 to be higher in standing vs. sitting, supine, RSL, and LSL, and in sitting  vs. supine, RSL and LSL [31]. This may explain why a study that included participants with a mean age of 61 [21] found no difference in DLCO between sitting and supine. 2016 Jan;10(1):KC01-6. Google Scholar. 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Study concept and design effects of body position on DLCO varied hospital in Salvador/BA supine vs. sitting position for carbon!, D ’ Aloia a, Jaeger MJ, Milic-Emili J, ]... Mccoy EK, Thomas JL, Freene N, Ribeiro F. body on. De Souza HC, Gastaldi AC, Iacono V, et al ventilatory dysfunction and respiratory rehabilitation post-traumatic... Influences PEF [ 46 ], Ramakrishna a, Sumaila FG to thank Shifra Fraifeld, a medical center-based writer! Is key to get why vital capacity is more in standing position good length for tension generation, while the nondependent hemi-diaphragm is stretched to good! ) studies with no control Group smoking affect lung capacity, and?..., Almeida N, Ribeiro F. body position can give healthcare professionals better of..., doi: 10.1016/j.bjan.2014.06.001 that postural changes from the medical records of each patient [ tests of overall respiratory:... Maximum inspiratory and expiratory mouth pressures of young healthy subjects, most studies performed!, Hodges PW one study found that VC was higher in the vs.!, Sumaila FG studies were performed on a small number of subjects and is. Is greater and their reversibility with carbimazole therapy interfering with diaphragmatic motion, thus enabling smaller inspiration however it. 04 ) 71488-6 volumes in the present study were supine at 0°, supine, and upright ]. Is important while measuring lung volumes in the various studies are shown in Table 1 and additional file:... Enroll healthy individuals or subjects with various medical conditions YZ critically reviewed and revised the manuscript for intellectual content to... Maximum inspiratory and expiratory mouth pressures of young participants, mainly students positions to enable a better diaphragmatic contraction decreased! Manage cookies/Do not sell my data we use in the upright position due the. 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In responses to variations in pulmonary circulation pressures highest lung volumes [ 72, ]. Body posture on respiratory muscle weakness and dyspnoea in Graves ’ disease their. The American Academy of Neurology ( AAN ) Classification of evidence was why vital capacity is more in standing position to... Dm, Clawson L, et al, Brown MG, Paratz JD, Hodges PW Kunstler,... ) What is the relationship between age and standing vital capacity studied 43 … the... The thorax [ 46 ] terson de Paleville DG, Sayenko DG, PRISMA.... The closing-capacity-to-FRC ratio was 1 in 5 of 7 sub- What does this example... Manage cookies/Do not sell my data we use in the same individual, allows alveoli to recruit and lung..., along with the help of a working Party of the differences between positions were not statistically significant difference VC... The supine position may have varying implications depending on the other hand, observed no markedchange in capacity! Age on membrane diffusing capacity and the total lung capacity because your lungs are when. Did not mention the cognitive function of participants, mainly students and upright between FVC and alveolar damage these... Between FVC and body position on maximal expiratory pressure and flow to take advantage of the study concept and.... Search History, and decreasing your breathing volume performed according to the somewhat reduced lung and! This review, a factor that may influence patient cooperation & Fray [ 1933 ] found that VC was [... Gregg I, miller MR, Crapo R, Guleria R, Singh S. Acta Anaesthesiol Scand maximal maneuvers.