{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T19:20:54Z","timestamp":1789586454064,"version":"build-2803163510"},"reference-count":31,"publisher":"European Respiratory Society (ERS)","issue":"1","license":[{"start":{"date-parts":[[2021,1,1]],"date-time":"2021-01-01T00:00:00Z","timestamp":1609459200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001807","name":"Funda\u00e7\u00e3o de Amparo \u00e0 Pesquisa do Estado de S\u00e3o Paulo","doi-asserted-by":"publisher","award":["2011\/20979-6"],"award-info":[{"award-number":["2011\/20979-6"]}],"id":[{"id":"10.13039\/501100001807","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003593","name":"Conselho Nacional de Desenvolvimento Cient\u00edfico e Tecnol\u00f3gico","doi-asserted-by":"publisher","award":["142298\/2016-6"],"award-info":[{"award-number":["142298\/2016-6"]}],"id":[{"id":"10.13039\/501100003593","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["publications.ersnet.org"],"crossmark-restriction":true},"short-container-title":["ERJ Open Res"],"accepted":{"date-parts":[[2020,5,30]]},"published-print":{"date-parts":[[2021,1]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Patients with unilateral diaphragmatic paralysis (UDP) may present with dyspnoea without specific cause and limited ability to exercise. We aimed to investigate the diaphragm contraction mechanisms and nondiaphragmatic inspiratory muscle activation during exercise in patients with UDP, compared with healthy individuals.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Pulmonary function, as well as volitional and nonvolitional inspiratory muscle strength were evaluated in 35 patients and in 20 healthy subjects. Respiratory pressures and electromyography of scalene and sternocleidomastoid muscles were continuously recorded during incremental maximal cardiopulmonary exercise testing until symptom limitation. Dyspnoea was assessed at rest, every 2\u2005min during exercise and at the end of exercise with a modified Borg scale.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main results<\/jats:title><jats:p>Inspiratory muscle strength measurements were significantly lower for patients in comparison to controls (all p&lt;0.05). Patients achieved lower peak of exercise (lower oxygen consumption) compared to controls, with both gastric (\u22129.8\u00b14.6 cmH<jats:sub>2<\/jats:sub>O<jats:italic>versus<\/jats:italic>8.9\u00b16.0\u2005cmH<jats:sub>2<\/jats:sub>O) and transdiaphragmatic (6.5\u00b15.5\u2005cmH<jats:sub>2<\/jats:sub>O<jats:italic>versus<\/jats:italic>26.9\u00b110.9\u2005cmH<jats:sub>2<\/jats:sub>O) pressures significantly lower, along with larger activation of both scalene (40\u00b122% EMGmax<jats:italic>versus<\/jats:italic>18\u00b114% EMGmax) and sternocleidomastoid (34\u00b122% EMGmax<jats:italic>versus<\/jats:italic>14\u00b18% EMGmax). In addition, the paralysis group presented significant differences in breathing pattern during exercise (lower tidal volume and higher respiratory rate) with more dyspnoea symptoms compared to the control group.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The paralysis group presented with exercise limitation accompanied by impairment in transdiaphragmatic pressure generation and larger accessory inspiratory muscles activation compared to controls, thereby contributing to a neuromechanical dissociation and increased dyspnoea perception.<\/jats:p><\/jats:sec>","DOI":"10.1183\/23120541.00357-2019","type":"journal-article","created":{"date-parts":[[2021,2,1]],"date-time":"2021-02-01T09:57:53Z","timestamp":1612173473000},"page":"00357-2019","update-policy":"https:\/\/doi.org\/10.1183\/ers-crossmark-policy","source":"Crossref","is-referenced-by-count":13,"title":["Unilateral diaphragmatic paralysis: inspiratory muscles, breathlessness and exercise capacity"],"prefix":"10.1183","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7108-5935","authenticated-orcid":false,"given":"Mayra","family":"Caleffi Pereira","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Let\u00edcia Z.","family":"Cardenas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeferson G.","family":"Ferreira","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vin\u00edcius C.","family":"Iamonti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pauliane Vieira","family":"Santana","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andr\u00e9","family":"Apanavicius","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pedro","family":"Caruso","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angelo","family":"Fernandez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos R.R.","family":"de Carvalho","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8738-9482","authenticated-orcid":false,"given":"Daniel","family":"Langer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andr\u00e9 L.P.","family":"de Albuquerque","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"81","published-online":{"date-parts":[[2021,2,1]]},"reference":[{"key":"2024101708255773000_7.1.00357-2019.1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1007236"},{"key":"2024101708255773000_7.1.00357-2019.2","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1016\/j.ccm.2018.01.012","article-title":"Disorders of the diaphragm","volume":"39","author":"McCool","year":"2018","journal-title":"Clin Chest Med"},{"key":"2024101708255773000_7.1.00357-2019.3","doi-asserted-by":"publisher","DOI":"10.1183\/20734735.025018"},{"key":"2024101708255773000_7.1.00357-2019.4","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.01214-2018"},{"key":"2024101708255773000_7.1.00357-2019.5","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1016\/j.resp.2017.11.006","article-title":"Exercise testing in patients with diaphragm paresis","volume":"248","author":"Bonnevie","year":"2018","journal-title":"Respir Physiol Neurobiol"},{"key":"2024101708255773000_7.1.00357-2019.6","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.2110016"},{"key":"2024101708255773000_7.1.00357-2019.7","doi-asserted-by":"publisher","DOI":"10.1378\/chest.93.3.580"},{"key":"2024101708255773000_7.1.00357-2019.8","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.05.00034905"},{"key":"2024101708255773000_7.1.00357-2019.9","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.05.00034805"},{"key":"2024101708255773000_7.1.00357-2019.10","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.05.00035005"},{"key":"2024101708255773000_7.1.00357-2019.11","doi-asserted-by":"publisher","DOI":"10.1590\/S0100-879X1999000600006"},{"key":"2024101708255773000_7.1.00357-2019.12","doi-asserted-by":"crossref","first-page":"729","DOI":"10.1590\/S0100-879X1999000600008","article-title":"Reference values for lung function tests. 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