{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T20:51:00Z","timestamp":1792011060096,"version":"4.4.0"},"reference-count":41,"publisher":"Wiley","issue":"21","license":[{"start":{"date-parts":[[2025,10,30]],"date-time":"2025-10-30T00:00:00Z","timestamp":1761782400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["physoc.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Physiological Reports"],"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    Whether extra\u2010diaphragmatic respiratory muscle output is altered in patients with unilateral diaphragm dysfunction (UDD) remains unclear. We compared respiratory pressures and muscle activity during symptom\u2010limited cardiopulmonary exercise testing (CPET) in 10 patients with UDD and 10 matched controls. Ventilatory variables, dyspnea, and electromyography (EMG) of the diaphragm, scalene, sternocleidomastoid, and parasternal intercostals were assessed at iso\u2010ventilation and peak ventilation. Compared to controls, patients with UDD showed lower peak workload and oxygen consumption (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.029), with a 10% lower but not statistically different peak ventilation (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.078). At peak, they were more likely to report high dyspnea (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.050). EMG patterns were similar between groups at iso\u2010ventilation (40\u2009L\/min). At peak, controls had greater diaphragm (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.007) and parasternal intercostal (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.042) activity, while UDD patients showed earlier activation of scalene (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.021) and sternocleidomastoid (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.049), and greater expiratory muscle recruitment (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.004). These findings suggest that patients with UDD rely on earlier and increased activation of extra\u2010diaphragmatic and expiratory muscles to compensate for reduced diaphragm function during intense exercise. Targeting these compensatory mechanisms may be beneficial in managing diaphragm dysfunction.\n                  <\/jats:p>","DOI":"10.14814\/phy2.70635","type":"journal-article","created":{"date-parts":[[2025,10,30]],"date-time":"2025-10-30T12:06:33Z","timestamp":1761825993000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Pattern of extra\u2010diaphragmatic respiratory muscle activity during exercise in patients with unilateral diaphragm dysfunction"],"prefix":"10.14814","volume":"13","author":[{"given":"Antenor","family":"Rodrigues","sequence":"first","affiliation":[{"name":"Keenan Centre for Biomedical Research Li Ka Shing Knowledge Institute, Unity Health Toronto  Toronto Ontario Canada"},{"name":"Interdepartmental Division of Critical Care Medicine University of Toronto  Toronto Ontario Canada"},{"name":"\u00c9cole de R\u00e9adaptation, Facult\u00e9 de M\u00e9decine Universit\u00e9 Laval  Quebec Quebec Canada"},{"name":"Centre de Recherche Institut Universitaire De Cardiologie Et De Pneumologie de Qu\u00e9bec (IUCPQ)  Quebec Quebec Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zafeiris","family":"Louvaris","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Sciences, Faculty of Movement and Rehabilitation Sciences, Research Group for Rehabilitation in Internal Disorders KU Leuven  Leuven Belgium"},{"name":"Respiratory Rehabilitation and Respiratory Division University Hospital Leuven  Leuven Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sauwaluk","family":"Dacha","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Sciences, Faculty of Movement and Rehabilitation Sciences, Research Group for Rehabilitation in Internal Disorders KU Leuven  Leuven Belgium"},{"name":"Respiratory Rehabilitation and Respiratory Division University Hospital Leuven  Leuven Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mayra Caleffi","family":"Pereira","sequence":"additional","affiliation":[{"name":"Pulmonary Division, Heart Institute (InCor), Hospital das Cl\u00ednicas HCFM USP, Faculdade de Medicina Universidade de S\u00e3oPaulo  S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tin","family":"Gojevic","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Sciences, Faculty of Movement and Rehabilitation Sciences, Research Group for Rehabilitation in Internal Disorders KU Leuven  Leuven Belgium"},{"name":"Respiratory Rehabilitation and Respiratory Division University Hospital Leuven  Leuven Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michele R.","family":"Schaeffer","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Sciences, Faculty of Movement and Rehabilitation Sciences, Research Group for Rehabilitation in Internal Disorders KU Leuven  Leuven Belgium"},{"name":"Respiratory Rehabilitation and Respiratory Division University Hospital Leuven  Leuven Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luc","family":"Janssens","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Sciences, Faculty of Movement and Rehabilitation Sciences, Research Group for Rehabilitation in Internal Disorders KU Leuven  Leuven Belgium"},{"name":"Department of Electrical Engineering, Faculty of Engineering Technology KU Leuven  Leuven Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wim","family":"Janssens","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Sciences, Faculty of Movement and Rehabilitation Sciences, Research Group for Rehabilitation in Internal Disorders KU Leuven  Leuven Belgium"},{"name":"Respiratory Rehabilitation and Respiratory Division University Hospital Leuven  Leuven Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"W. Darlene","family":"Reid","sequence":"additional","affiliation":[{"name":"Interdepartmental Division of Critical Care Medicine University of Toronto  Toronto Ontario Canada"},{"name":"Department of Physical Therapy University of Toronto  Toronto Ontario Canada"},{"name":"KITE, Toronto Rehabilitation Institute University Health Network  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ghislaine","family":"Gayan\u2010Ramirez","sequence":"additional","affiliation":[{"name":"Keenan Centre for Biomedical Research Li Ka Shing Knowledge Institute, Unity Health Toronto  Toronto Ontario Canada"},{"name":"Interdepartmental Division of Critical Care Medicine University of Toronto  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dries","family":"Testelmans","sequence":"additional","affiliation":[{"name":"Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism (CHROMETA) KU Leuven  Leuven Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laurent","family":"Brochard","sequence":"additional","affiliation":[{"name":"Keenan Centre for Biomedical Research Li Ka Shing Knowledge Institute, Unity Health Toronto  Toronto Ontario Canada"},{"name":"Interdepartmental Division of Critical Care Medicine University of Toronto  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0444-8606","authenticated-orcid":false,"given":"Rik","family":"Gosselink","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Sciences, Faculty of Movement and Rehabilitation Sciences, Research Group for Rehabilitation in Internal Disorders KU Leuven  Leuven Belgium"},{"name":"Respiratory Rehabilitation and Respiratory Division University Hospital Leuven  Leuven Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Langer","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Sciences, Faculty of Movement and Rehabilitation Sciences, Research Group for Rehabilitation in Internal Disorders KU Leuven  Leuven Belgium"},{"name":"Respiratory Rehabilitation and Respiratory Division University Hospital Leuven  Leuven Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,10,30]]},"reference":[{"issue":"1","key":"e_1_2_10_2_1","article-title":"Inspiratory muscle training, with or without concomitant pulmonary rehabilitation, for chronic obstructive pulmonary disease (COPD)","volume":"1","author":"Ammous O.","year":"2023","journal-title":"Cochrane Database of Systematic Reviews"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1093\/ptj\/pzaa171"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.14814\/phy2.14522"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.resp.2017.11.006"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.3389\/fmed.2023.1284689"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1183\/23120541.00357-2019"},{"issue":"3","key":"e_1_2_10_8_1","first-page":"378","article-title":"The role of the scalene and sternomastoid muscles in breathing in normal subjects; an electromyographic study","volume":"89","author":"Campbell E. 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