Functional Assessment and Pulmonary Rehabilitation: Challenges and Perspectives for Comprehensive Care

Individuals with Chronic Obstructive Pulmonary Disease (COPD) present with respiratory muscle dysfunction, characterized by reduced diaphragmatic contractility and mobility due to pulmonary hyperinflation, oxidative stress, and systemic inflammation. Effective assessment of diaphragmatic function is crucial for monitoring progress in pulmonary rehabilitation programs. This study aims to evaluate diaphragmatic function and mobility in COPD patients undergoing pulmonary rehabilitation with inspiratory muscle training, using ultrasound, and to identify associations between diaphragmatic dysfunction and clinical symptoms such as dyspnea and fatigue. A randomized clinical trial will be conducted to investigate the impact of rehabilitation on diaphragmatic function, correlating it with pulmonary function and physical performance.

This study aims to evaluate diaphragmatic muscle function and mobility through ultrasonography in individuals diagnosed with Chronic Obstructive Pulmonary Disease (COPD) undergoing a pulmonary rehabilitation program combined with inspiratory muscle training (IMT). The research will investigate the relationship between diaphragmatic behavior, clinical severity, and the repercussions on respiratory capacity. Upon meeting the inclusion criteria, participants will undergo an initial clinical and sociodemographic assessment, including medical history, spirometry, manovacuometry, and the 6-Minute Walk Test (6MWT). Symptom impact and dyspnea will be measured using the COPD Assessment Test (CAT) and the mMRC scale. Participants will then be allocated into two groups: IMT Group (IMTG): Participants will perform IMT using the PowerBreathe Classic (3 sets of 10 reps; load increasing from 50% to 60% of MIP), followed by resistance training (60-70% of 1RM) and aerobic training (20 minutes on a stationary bike at 60-80% intensity based on the Karvonen Formula and Borg Scale 4-6). Control Group (CG): Participants will undergo the exact same resistance and aerobic training protocols as the IMTG. However, they will perform a Sham IMT using the device at its minimum load setting (3 sets of 10 reps) to maintain the same training volume and procedural consistency without the threshold training effect.