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Original Research: COPD |

Impairments in Systems Underlying Control of Balance in COPDBalance in COPD

Marla K. Beauchamp, MScPT; Kathryn M. Sibley, PhD; Bimal Lakhani, MSc; Julia Romano, MSc; Sunita Mathur, PhD; Roger S. Goldstein, MD, FCCP; Dina Brooks, PhD, PT
Author and Funding Information

From the Graduate Department of Rehabilitation Science (Ms Beauchamp, Mr Lakhani, and Dr Brooks), and the Department of Physical Therapy (Drs Sibley, Mathur, Goldstein, and Brooks), University of Toronto; Respiratory Medicine (Mss Beauchamp and Romano and Drs Mathur, Goldstein, and Brooks), West Park Healthcare Centre; and Toronto Rehabilitation Institute (Drs Sibley and Brooks and Mr Lakhani), Toronto, ON, Canada.

Correspondence to: Dina Brooks, PhD, PT, Department of Physical Therapy, University of Toronto, 160-500 University Ave, Toronto, ON, M5G 1V7, Canada; e-mail: dina.brooks@utoronto.ca


Funding/Support: This work was supported by the Ontario Respiratory Care Society of the Ontario Lung Association. Dina Brooks is supported by a Canada Research Chair and Marla Beauchamp by the Canadian Institutes of Health Research.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


© 2012 American College of Chest Physicians


Chest. 2012;141(6):1496-1503. doi:10.1378/chest.11-1708
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Background:  Although balance deficits are increasingly recognized in COPD, little is known regarding the disordered subcomponents underlying the control of balance. We aimed to determine the specific components of balance that are impaired in COPD and to investigate the association among balance, peripheral muscle strength, and physical activity.

Methods:  Balance, physical activity, and lower extremity muscle strength were assessed in 37 patients with COPD and 20 age-matched healthy control subjects using the Balance Evaluation Systems Test (BESTest), the Physical Activity Scale for the Elderly, and an isokinetic dynamometer, respectively. A subset of subjects (20 patients with COPD and 20 control subjects) underwent a second testing session in which postural perturbations were delivered using a lean-and-release system.

Results:  Subjects with COPD (age, 71 ± 7 years; FEV1, 39% ± 16% predicted) exhibited significantly lower scores than did control subjects (age, 67 ± 9 years) on all of the BESTest subscales (all P < .001). In response to anterior perturbations, subjects with COPD showed a longer time to foot-off (P = .027) and foot contact (P = .018), and a longer duration anticipatory phase (P = .008) compared with control subjects. Muscle strength (P = .008) and self-reported physical activity (P = .033) explained 35% of the variance in balance in subjects with COPD.

Conclusions:  Individuals with COPD exhibit impairments in all balance subcomponents and demonstrate slower reaction times in response to perturbations. Deficits in balance are associated with reduced physical activity levels and skeletal muscle weakness.

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