Abstract
Background:
The respiratory movements are one of the factors influencing standing balance. Although well-trained athletes have better postural performance compared to untrained men, it's not quite clear, if the formers' upright posture would be more stable during different ventilation modes, maximal voluntary hyperventilation and inspiratory breath-holding. There are no studies on this subject in the available literature.Objectives:
The aim of this study was to investigate an influence of maximal inspiratory breath-holding and maximal voluntary hyperventilation on the standing balance of athletes.Patients and Methods:
We assessed the amplitude and the velocity of postural sway in the athletes (n = 38) and untrained subjects (n = 28) by the force platform. The frequency characteristics of the center of pressure (CP) oscillations' were also analyzed. The amplitude and the frequency of respiratory movements were estimated by the strain gauge.Results:
It was found that during quiet breath velocity and frequency of CP oscillations were lower in the athletes. Breath holding led to an increase of velocity and frequency of CP displacement in both groups, increase of these indices was more pronounced in the athletes. Maximal voluntary hyperventilation caused a significant increase of all stabilographic indices in both groups. Increase of frequency and amplitude of respiratory movements were mainly observed during hyperventilation in athletes and it caused an increase of the velocity of CP displacement. Changes of sway amplitude were the same in both groups.Conclusions:
Breath holding led to activation of the postural control, which was more pronounced in the athletes. Hyperventilation caused an impairment of the postural stability. The athletes' postural system compensated the impact of hyperventilation more efficiently versus controls, but it was achieved at the expense of greater effort.Keywords
1. Background
It is known that well-trained athletes demonstrate better postural stability compared to untrained men (1, 2). Physical training influences the postural control in several possible ways. First, athletes integrate information from different sensory systems much better than non-athletes (3). Second, regular sport activity leads to an improvement of sensitivity of proprioceptors. Proprioceptive afferences, in turn, are important sensory cues to the postural control system (4). Balter et al. postulate that a superior balance of athletes is a result of their better motor abilities (5). Respiration is one of the factors influencing standing balance, since the respiratory movements perturb postural stability (6). However, these perturbations are compensated by the movements of other parts of the body during quiet breathing (7). On the contrary, deep and fast breathing causes a decrease of postural stability due to more pronounced impact of the respiratory movements on the balance (8). Since ventilation increases during exercise, one can assume that respiration is one of the factors decreasing postural performance. So it can be speculated that fast and deep breath is an important factor influencing balance in athletes during training and competitions. On the other hand, regular physical training improves respiratory functions (9). During maximal voluntary hyperventilation, athletes probably breathe faster and deeper versus sedentary men. Hence, the impact of maximal hyperventilation on a postural stability of athletes could be stronger versus non-athletes. Therefore, athletes may not demonstrate better balance during hyperventilation. It is not quite clear if athletes' upright posture would be more stable under the influence of increased ventilation compared to sedentary subjects or not. Athletes are known to hold their breath during different sport activities. For example, weightlifters hold breath after maximal inspiration during lifting tasks (10). A breath-holding preceding a trigger pull takes place in rifle shooters (11). It is considered that apnea improves postural stability due to the absence of impact of respiratory movements on the postural control system (12). But such a proposition, possibly, is doubtful. There is evidence (13) that during breath holding respiratory muscles make strong low amplitude high frequency contractions. Perhaps, these contractions are a perturbing factor for postural stability, so apnea doesn't improve standing balance. In summary, it can be speculated that understanding of the influence of hyperventilation and breath-holding on a postural stability in athletes is rather important. Meanwhile, there are no studies on this subject in the available literature.
2. Objectives
The aim of this study was to compare the standing balance of athletes and non-athletes during maximal inspiratory breath-holding and maximal voluntary hyperventilation.
3. Patients and Methods
3.1. Subjects
Sixty-six volunteers participated in the study. The volunteers were divided into two groups: “Athletes” and “Controls”. The “Athletes” group included 19 men and 19 women aged 19.8 ± 1.0 years, they regularly (11.2 ± 4.5 hours a week) trained during 7.6 ± 4.6 years in field athletics, combative and team sports. The “Control” group consisted of healthy untrained volunteers (10 men and 18 women) aged 22.4 ± 4.6 years. All participants gave informed consent, and approval of the local Ethics Committee was obtained before the study.
3.2. Procedure
Standing balance was assessed using the force platform “Stabilan 01-2” (ZAO OKB “RITM”, Russia). The data from the force platform were sampled at 50Hz and were filtered by two analog low-pass filters with a bandwidth of 7 kHz and a bandwidth of 15 Hz. Then the signal was filtered in the analog-to-digital converter using a third-order Sinc filter with a frequency of 50 Hz resection. The study consisted of three trials: “Quiet breath”, “Apnea” and “Hyperventilation”. During the “Quiet Breath” trial the participants breathed quietly, during the “Apnea” they held their breath after maximal inspiration, and during “Hyperventilation” the subjects breathed as deep and fast as possible. Duration of all trials was 20 seconds with a rest period (10 minutes) between them. During the tests the participants stood upright as still as possible on the force platform with their heels 2 cm apart, feet at an angle of 30 degrees and looked at the white circle on the black background. The stabilographic signals from the force platform were filtered and processed by specialized software (StabMed 2010, ZAO OKB “RITM”, Russia). The following stabilographic parameters were calculated: the mean velocity (V, mm s-1) and variance of the center of pressure (CP) displacement in the medio-lateral (QmL, mm) and the antero-posterior (Qap, mm) plane and the surface area covered by the trajectory of the CP with a 90% confidence interval (S, mm2). The mean velocity of CP movement shows an amount of activity required to maintain stability, i.e. this index provides an assessment of functional activity of the postural control system. The variance of CP displacements characterizes, essentially, the amplitude of postural sway, so the smaller the variance, the better postural stability (14). A frequency analysis of the stabilographic signal was also performed by the StabMed software. The whole frequency band was divided into three ranges: low frequency (0-0.2 Hz), medium frequency (0.2-2 Hz) and high frequency (2-6 Hz) (15). The following indices were calculated: spectrum power (%) in the low (Pw1), medium (Pw2) and high (Pw3) frequency range in the medio-lateral (Pw1mL, Pw2mL and Pw3mL) and the antero-posterior (Pw1ap, Pw2ap and Pw3ap) plane. We also estimated the frequency corresponding to 60% level of the total spectral power in the medio-lateral (60% Pwml, Hz) and the antero-posterior (60% Pwap, Hz) plane. Frequency of CP oscillations reflects the mechanisms of postural control. It is considered, that high frequencies are related to using proprioceptive infor-mation, medium frequencies are responsible for the cerebellar one, and low-for the visual (16).
3.3. Ventilation Assessment
The respiratory indices were estimated using strain gauge, which was wrapped around the participants’ chest. The strain gauge sensor recorded the alteration of the chest circumference during respiratory movements (17). So we measured the respiration frequency (f, min-1) and the respiratory amplitude (RA). The last parameter was calculated as mean of differences between maximum of the inspirations and minimum of the expirations of all breathing cycles during the trial. We also calculate the indirect ventilation index (Vent) as the product of f and RA.
3.4. Statistics
All results are expressed as Mean ± standard deviation. The data analysis was performed with a two-way analysis of variance with one between-groups factor (two levels: athletes and non-athletes) and one within-groups factor with repeated measures (two levels of respiration: quiet breath and hyperventilation for the respiratory indices and three levels of respiration: Apnea, Quiet breath and Hyperventilation for the stabilographic indices). Post-hoc comparisons were made using the least square differences (LSD) criterion. Pearson’s correlation (r) was used to investigate the relations between the respiratory and stabilographic indices.
4. Results
4.1. Ventilation
All respiratory parameters were increased during hyperventilation trial in both groups (Table 1). However, in the athletes elevation of RA (P = 0.01) and Vent (P = 0.003) parameters was higher, so the athletes breathed deeper and faster compared to controls.
4.2. Postural Indices
We found that during quiet breath V and Pw3ap were lower in the athletes versus control subjects. There was an increase of V during the inspiratory breath-holding in both groups (Table 2), and it was more pronounced in the athletes. Sway amplitude didn't change during apnea in both groups. Besides, there was shift of the spectrum of stabilographic signal toward the high-frequency range: Pw1ap decreased, Pw3ap and 60% Pwap increased in both groups, Pw2ap increased in the athletes (Table 2). All stabilometric indices were significantly increased in both groups during maximal voluntary hyperventilation, reflecting a severe impairment of the postural stability (Table 2). The velocity of the CP displacement (P = 0.005) as well as the power of the high-frequency spectrum range (P = 0.002 for Pw3mL, P = 0.0003 for Pw3ap) and the 60% level of total spectral power in the antero-posterior plane (P = 0.01) increased to a greater extent in the athletes whereas other indices changed in the same way in both groups.
| Apnea | Quiet Breath | Hyperventilation | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Control | Athletes | P Valuec | Control | Athletes | P Valuec | Control | Athletes | P Valuec | P Valued | |
| QmL, mm | 2.63 ± 1.11 | 2.24 ± 0.82 | 0.2 | 2.31 ± 0.67 | 2.11 ± 0.81 | 0.5 | 4.02 ± 1.33e | 3.98 ± 1.35e | 0.9 | 0.6 |
| Qap, mm | 3.16 ± 1.51 | 2.78 ± 1.21 | 0.8 | 3.02 ± 1.09 | 2.7 ± 0.82 | 0.8 | 6.17 ± 2.00e | 6.55 ± 2.40e | 0.7 | 0.3 |
| V, mm s-1 | 9.83 ± 2.86e | 8.81 ± 2.51e | 0.8 | 8.51 ± 2.28 | 7.06 ± 1.68 | 0.02 | 25.45 ± 11.12e | 37.76 ± 29.00e | 0.0006 | 0.005 |
| S, mm2 | 117.30 ± 89.09 | 84.76 ± 51.3 | 0.38 | 98.53 ± 57.29 | 76.22 ± 34.15 | 0.54 | 346.1 ± 205.51e | 386.7 ± 245.6e | 0.3 | 0.3 |
| 60% PwmL, Hz | 0.67 ± 0.21 | 0.71 ± 0.2 | 0.45 | 0.66 ± 0.21 | 0.66 ± 0.17 | 0.98 | 0.83 ± 0.25f | 0.99 ± 0.31e | 0.007 | 0.1 |
| Pw1mL, % | 25.25 ± 9.85 | 25.03 ± 7.13 | 0.92 | 29.29 ± 10.90 | 27.97 ± 8.73 | 0.56 | 25.26 ± 9.24 | 21.39 ± 9.51f | 0.08 | 0.5 |
| Pw2mL, % | 64.15 ± 8.97 | 63.97 ± 6.55 | 0.93 | 60.43 ± 8.98 | 61.53 ± 7.68 | 0.59 | 61.43 ± 7.79 | 61.03 ± 8.36 | 0.8 | 0.8 |
| Pw3mL, ,% | 10.68 ± 2.74 | 10.92 ± 2.70 | 0.81 | 10.29 ± 2.54 | 10.39 ± 2.89 | 0.92 | 13.32 ± 3.52f | 17.45 ± 6.25e | 0.0002 | 0.002 |
| 60% Pwap , Hz | 0.77 ± 0.21g | 0.81 ± 0.21f | 0.64 | 0.66 ± 0.16 | 0.59 ± 0.19 | 0.43 | 1.00 ± 0.24e | 1.23 ± 0.52e | 0.006 | 0.01 |
| Pw1ap, ,% | 28.54 ± 10.34g | 25.71 ± 9.7g | 0.27 | 33.93 ± 6.95 | 33.47 ± 10.32 | 0.86 | 22.82 ± 7.60e | 20.29 ± 9.71e | 0.3 | 0.7 |
| Pw2ap, % | 56.36 ± 8.56 | 59.32 ± 7.84g | 0.20 | 53.00 ± 6.11 | 55.13 ± 8.89 | 0.35 | 57.96 ± 7.50 | 55.45 ± 8.73 | 0.3 | 0.09 |
| Pw3ap, % | 15.11 ± 4.37f | 15.00 ± 3.56e | 0.94 | 13.07 ± 3.02 | 11.39 ± 2.83 | 0.02 | 19.25 ± 4.67e | 24.34 ± 9.46e | 0.001 | 0.0003 |
4.3. Correlations Between Respiratory and Stabilographic Indices During Hyperventilation
We found that at hyperventilation f was related to QmL, S, V, 60% PwmL, 60% Pwap, Pw1ap, Pw3mL, Pw3ap, and Vent correlated with V, Pw3ap, 60% Pwap and Pw3ap (Table 3). One can see that the closest correlations were obtained for the frequency of respiratory movements with the velocity of CP displacement, 60% power of total spectral energy and the spectrum power in the high-frequency range. The respiratory amplitude wasn't related to any stabilographic parameter.
Correlations (r) Between Respiratory and Stabilographic Indices During Hyperventilation
| Respiratory Amplitude | Respiration Frequency | Ventilation Index | |
|---|---|---|---|
| variance of the CP displacement in the medio-lateral plane, QmL | 0.03 | 0.30a | 0.21 |
| variance of the CP displacement in the antero-posterior plane, Qap | 0.05 | 0.13 | 0.10 |
| Mean velocity of the CP displacement | -0.15 | 0.56b | 0.25a |
| Surface area covered by the trajectory of the CP with a 90% CI | -0.003 | 0.29a | 0.15 |
| 60% level of the total spectral power in the medio-lateral plane PwmL | -0.10 | 0.39c | 0.22 |
| Power in the low frequency range in the medio-lateral plane Pw1mL | 0.09 | -0.17 | -0.07 |
| Power in the medium range in the medio-lateral plane, Pw2mL | -0.08 | -0.23 | -0.21 |
| Power in the high frequency range in the medio-lateral plane, Pw3mL | -0.04 | 0.63b | 0.41c |
| 60% level of the total spectral power in the antero-posterior plane, Pwap | -0.10 | 0.58b | 0.35c |
| Power in the low frequency range in the antero-posterior plane, Pw1ap | 0.09 | -0.32c | 0.001 |
| Power in the medium frequency range in the antero-posterior plane, Pw2ap | -0.13 | -0.18 | -0.29a |
| Power in the high frequency range in the antero-posterior plane, Pw3ap | 0.03 | 0.54b | 0.47b |
Acknowledgements
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