Assessment of Correlations Between Amplitude of Thoracic and Diaphragmatic Mobility in Healthy Adults

Assessment of Correlations Between Amplitude of Thoracic and Diaphragmatic Mobility in Healthy Adults | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Assessment of Correlations Between Amplitude of Thoracic and Diaphragmatic Mobility in Healthy Adults Tomasz Wloch, Anna Olbrych, Mateusz Groszyk, Jakub Marchewka, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8511981/v1 This work is licensed under a CC BY 4.0 License Status: Under Revision Version 1 posted 10 You are reading this latest preprint version Abstract Introduction: Thoracic and diaphragmatic mobility are key components of respiratory mechanics and jointly contribute to effective ventilation. Simple clinical tools, such as tape-based chest expansion measurements and ultrasound assessment of diaphragmatic excursion, are increasingly used in respiratory and physiotherapy practice. However, the physiological relationship between thoracic and diaphragmatic mobility assessed using these methods has not been sufficiently explored. Objectives This study aimed to investigate the association between thoracic mobility measured at different chest levels and diaphragmatic mobility assessed using ultrasonography in healthy adults. Material and methods Thirty healthy adults participated in this cross-sectional study. Thoracic mobility was assessed using tape measurements during maximal inspiration and expiration at three levels: axillary, sternal, and xiphoid. Diaphragmatic mobility was evaluated as diaphragmatic excursion using M-mode ultrasonography. Results Significant positive correlations were observed between diaphragmatic excursion and thoracic mobility at all measured chest levels, with the strongest association at the axillary level (r = 0.53). Age and BMI were negatively associated with both diaphragmatic and thoracic mobility, while no significant sex-related differences were observed. Conclusions These findings support the concept of functional coupling between thoracic and diaphragmatic components of respiratory mechanics. ultrasound respiratory mechanics thoracic mobility diaphragm mobility Figures Figure 1 Introduction A properly functioning respiratory system is one of the basic mechanisms ensuring proper functioning of the body. Respiratory efficiency depends on both internal factors, i.e. those related to the lungs and bronchi, and external ones regarding respiratory mobility of the chest. In thoracic mobility, two main phases of breathing can be distinguished: inhalation and exhalation. Inhalation is associated with the increase in chest volume, while exhalation concerns its decrease. During inhalation, the diaphragm, which is the main respiratory muscle, contracts. This causes an increase in the longitudinal dimension and a decrease in the pressure in the chest (negative pressure is created). An increase in the upper-lower dimension is not the only change that occurs due to contraction of the diaphragm. The shape of the chest also changes and the ribs move. Thanks to the external intercostal muscles, the sternum is raised and the ribs are lifted which, in turn, causes the chest to widen and deepen. In a correct breathing pattern, the chest and abdominal cavity are simultaneously activated. The interaction of these structures enables proper gas exchange and adaptation of the respiratory system to changing physiological loads. Limiting their mobility can lead to respiratory dysfunctions and is associated with assuming a compensatory breathing pattern. Dysfunctional breathing patterns have been documented in patients with asthma [ 1 ], chronic back and neck pain [ 2 ], circulatory system diseases [ 3 ], anxiety and depression [ 4 ]. The study of breathing mechanics is an important element of diagnostics. There are a number of methods used for measuring thoracic mobility, from those very simple and undemanding to ones that are expensive and complicated, such as optoelectronic plethysmography, respiratory inductive plethysmography or photogrammetry [ 5 ]. Despite their non-invasiveness and high measurement accuracy, these methods require the use of expensive, specialist devices, which is why they are not very popular and are rather a subject of interest in research centres. Undoubtedly, one of the simplest methods is to measure chest circumference with a tape measure. Such a technique is used both in clinical practice and for scientific purposes. In turn, ultrasonography is applied in the assessment of diaphragm function [ 6 ]. This method is gaining increasing recognition due to its availability, safety and high diagnostic value. Objective Taking the interdependence of the diaphragmatic and thoracic mobility into account, the aim of the presented study was to assess correlations between chest and diaphragmatic mobility. Material and methods The study involved 30 individuals, including 17 men and 13 women aged 28 to 69 years (42.37 ± 7.36 years) (Table 1 ). These participants were completely healthy, recruited from the general population, in whom respiratory problems, chest deformities and postural defects were excluded. The research was conducted in controlled conditions, with uniform measurement procedures for all participants. Consent to conduct the study was obtained from the Bioethical Committee (No. 126/KBL/OIL/2023) at the District Medical Chamber in Kraków. Written informed consent was obtained from all participants prior to participation in the study. Table 1 Characteristics of the study group Variable Total Women Men Mean ± SD Min Max Mean ± SD Min Max Mean ± SD Min Max Age [years] 46.70 ± 11.08 28 69 43.38 ± 10.79 28 65 49.23 ± 10.92 29 69 Body mass [kg] 78.53 ± 13.83 50 109 71.84 ± 12.08 50 92 83.65 ± 15 59 109 Body height [cm] 170.27 ± 8.21 155 191 163.92 ± 5.42 155 174 172.12 ± 6.52 165 191 BMI [kg/m²] 27.02 ± 3.92 20.20 35.30 26.68 ± 3.88 20.2 33.1 27.27 ± 4.05 20.7 35.3 SD – standard deviation; Min – minimum measurement obtained; Max – maximum measurement obtained; BMI – Body Mass Index Measurement of thoracic mobility using measuring tape (in cm) During the study, two chest circumference measurements were taken: during maximum inhalation and maximum exhalation, and the difference between them was considered the amplitude of thoracic mobility at this level. In further analysis, the average mobility for the chest was also calculated. In accordance with recommendations found in literature on the subject, measurements were taken in free standing position, at three levels: at the height of the underarms (axillary level), at the mastoid line and at the level of the xiphoid process. The axillary measurement was taken with the arms raised above the head, while the remaining measurements were performed with the arms lowered [ 7 ]. Assessment of diaphragmatic mobility The measurement of diaphragm mobility was performed using the Mindray ultrasound scanner using a convex transducer and the M-mode imaging setting. During the measurement, the patients were in the supine position with their lower limbs flexed at the hips and knees, their hands behind their heads. The liver was used as an acoustic window for subcostal projection. The transducer was positioned in the midclavicular line, directed cranially to make the diaphragm dome as visible as possible. In the image, the diaphragm dome can be seen as a distinct hyperechoic line located at the bottom of the screen. During respiration, this line assumes a sinusoidal shape, where the upward deflection corresponds to inhalation (the diaphragm dome moves towards the front of the transducer) and the downward deflection corresponds to exhalation. Depth measurement can be obtained on the M-mode image by marking the depth difference between the peak of inhalation and exhalation. Methods of statistical analysis Descriptive analysis and the Shapiro-Wilk test were used to assess the normality of data distribution. For data with normal distribution, the Student's t -test and Pearson's correlation coefficient were used. For non-normally distributed data, the Mann-Whitney test and Spearman's correlation coefficient were applied. The level of statistical significance was assumed at the level of p < 0.05. The minimum, maximum, arithmetic mean and standard deviation were calculated for the age, body mass and height, BMI, difference in circumference at the axilla, mastoid line, xiphoid process and diaphragm amplitude as well as the mean difference in chest circumference of the subjects. Results The measurements of thoracic mobility performed at three different levels and the measurements of diaphragmatic mobility using ultrasound are presented in Tables 2 (for the whole group) and 3 (divided according to gender). No significant differences were observed between the results obtained for women and men ( p > 0.05). Table 2 Obtained results for thoracic mobility in the whole group (n = 30) Variable Mean ± SD Min Max Inhalation – at axilla level [cm] 98.77 ± 9.19 75 113 Exhalation – at axilla level [cm] 96.05 ± 9.17 73 110 Circumference difference at axilla level [cm] 2.72 ± 1.16 1.00 6.00 Inhalation – at mastoid level [cm] 102.47 ± 9.15 79 118 Exhalation – at mastoid level [cm] 99.8 ± 9.61 75 116 Circumference difference at mastoid level [cm] 2.67 ± 1.40 0.00 5.00 Inhalation – at xiphoid process level [cm] 94.30 ± 10.16 72 112 Exhalation – at xiphoid process level [cm] 91.88 ± 10.39 70 111 Circumference difference at xiphoid process level [cm] 2.42 ± 1.72 -2.00 5.00 Mean difference in chest circumference [cm] 2.60 ± 1.14 0.33 5.33 Amplitude of diaphragmatic mobility [cm] 1.79 ± 0.63 0.88 3.03 SD – standard deviation; Min – minimum obtained measurement; Max – maximum obtained measurement Table 3 Obtained results for thoracic mobility according to gender Variable Women (n = 13) Men (n = 17) Mean ± SD Min Max Mean ± SD Min Max Inhalation – at axilla level [cm] 92.73 ± 9.07 75 111 103.38 ± 6.26 94 113 Exhalation – at axilla level [cm] 89.88 ± 8.85 73 107 100.76 ± 6.25 91 110 Circumference difference at axilla level [cm] 2.85 ± 0.90 2 5 2.62 ± 1.34 1 6 Inhalation – at mastoid level [cm] 99.85 ± 11.45 79 118 104.47 ± 6.61 93 117 Exhalation – at mastoid level [cm] 96.92 ± 11.76 75 115 102.00 ± 7.18 89 116 Circumference difference at mastoid level [cm] 2.92 ± 1.04 1 5 2.47 ± 1.62 0 5 Inhalation – at xiphoid process level [cm] 86.77 ± 8.33 72 100 100.06 ± 7.33 89 112 Exhalation – at xiphoid process level [cm] 84.81 ± 8.72 70 97 97.29 ± 8.17 84 111 Circumference difference at xiphoid process level [cm] 1.96 ± 1.81 -2 5 2.76 ± 1.64 0 5 Mean difference in chest circumference [cm] 2.58 ± 0.95 0.67 4.33 2.62 ± 1.30 0.33 5.33 Amplitude of diaphragmatic mobility [cm] 1.82 ± 0.63 0.88 2.8 1.76 ± 0.65 0.93 3.03 SD – standard deviation; Min – minimum obtained measurement; Max – maximum obtained measurement It was found that the distribution of age, BMI, diaphragm mobility amplitude and the difference in chest circumference at the height of the axilla, mastoid bone, xiphoid process and the mean for the chest is normal, p > 0.05. Therefore, Pearson’s correlation coefficient was calculated between these variables. The distribution of results for the difference in circumference at the height of the axilla was not normal, p < 0.05, thus, its correlations with other variables were calculated using Spearman’s correlation coefficient. Correlations were calculated between age and BMI, and the differences in measurements of circumference at the height of the axilla, mastoid, xiphoid process and the mean difference in measurements for the chest. These results are presented in Table 4 . Table 4 Correlation coefficients between age, BMI and difference in conducted measurements Variable Amplitude of diaphragmatic mobility [cm] Thoracic mobility Diaphragm Axilla level Mastoid level Xiphoid process level Mean difference of chest circumference Age -0.55 -0.37 -0.34 -0.37 -0.43 BMI -0.19 -0.30 -0.43 -0.15 -0.27 BMI – Body Mass Index According to the data presented in Table 4 , negative correlation coefficients were found between age and BMI and the amplitude of diaphragm mobility, as well as chest mobility at its various levels (axillae, mastoid, xiphoid process, mean difference). The strongest correlation was observed between age and the amplitude of diaphragmatic mobility (r = -0.55), which means a strong negative relationship – along with the increase in the age of the subjects, the amplitude of diaphragmatic mobility clearly decreased. In the case of the remaining measurements (chest), the correlations ranged from − 0.15 to -0.43, which was interpreted as weak or moderate relationships. In turn, the correlation values ​​between BMI and mobility amplitude were also negative, with the strongest relationship being noted in the measurement of chest mobility at the mastoid level (r = -0.43). These results allow to suggest that greater body mass may limit both diaphragmatic mobility and thoracic expansion during inhalation. Correlation coefficients were also calculated between the amplitude of diaphragm mobility and the differences in measurements of circumference at the axilla, mastoid, xiphoid process, and the mean difference in measurements for the chest. The results are presented in Table 5 . Table 5 Correlation coefficients between amplitude of diaphragmatic mobility and the differences in circumference measurements at the level of the axilla, mastoid, xiphoid process and the mean difference in measurements of the chest Variable Thoracic mobility Axilla level Mastoid level Xiphoid process level Mean difference of chest circumference Diaphragm 0.53 0.36 0.22 0.43 Correlation strength was interpreted as: r ≥ 0.5 strong, 0.3–0.49 moderate, < 0.3 weak. The coefficients calculated for the amplitude of diaphragmatic mobility and the differences in circumference measurements at the remaining heights are positive, which means that the higher the measured amplitude of the diaphragm, the larger the remaining circumferences (amplitude of thoracic mobility). The correlation between the difference in the measurements of diaphragm amplitude and the mobility of the chest at the axilla level is particularly strong p < 0.5 (r = 0.53), which – according to the adopted classification of the dependence strength – means a strong statistical relationship. The correlations for the mobility of the chest at the level of the mastoid bone (r = 0.36) and xiphoid process (r = 0.22) also demonstrate relationships — moderate and weak, respectively. Confirmation of this relationship indicates that individuals with greater diaphragm mobility also exhibit increased thoracic mobility, which confirms the functional cooperation of both respiratory mechanisms. There was no significant difference between the results for women and men, p > 0.05. Men were not found to demonstrate significantly greater diaphragmatic mobility, nor were women noted to show greater thoracic mobility. Discussion The chest is an effective respiratory pump that moves in response to the coordinated actions of the diaphragm and intercostal muscles. Mobility restriction in one of these structures can significantly affect the function of the other, leading to an increase in the work of breathing. The results of the study by Saeed et al. [ 8 ] allow to indicate that pulmonary rehabilitation, including rib cage mobilisation and diaphragm strengthening exercises, significantly improves the cooperation of these structures and increases maximum respiratory pressures. The examination of both thoracic and diaphragmatic mobility is essential for assessing breathing patterns. A simple and inexpensive tool for measuring chest expansion is a measuring tape. Using it, the chest circumference is measured during maximum inhalation and maximum exhalation at specific levels. In a study by Bockenhauer [ 9 ] on the reliability of thoracic mobility measurements using a centimetre (tailor's) tape, high repeatability was shown of this method (ICC 0.99). For that reason, it has been used in many studies [ 10 – 12 ]. Ultrasonography has been applied in the assessment of the diaphragm, which is a non-invasive, safe and repeatable method for measuring its thickness and mobility. Due to its advantages, it is a standard in the study of respiratory mechanics [ 13 , 14 ]. It is implemented to evaluate its mobility in various disease states [ 15 – 17 ]. Due to the multitude of methods used in assessing lung function and chest mobility, the task of science is to assess the correlation of results obtained using these methods. The work by Reddy et al. [ 18 ] fits into the trend of such searches, in which the authors assessed both the reliability of thoracic mobility measurements using a measuring tape (cm) and their correlations with spirometric parameters such as FEV₁, FVC and FEV₁/FVC. The intrarater reliability for upper and lower CE (chest expansion) showed very good agreement with intraclass correlation (ICC) values between 0.90 and 0.93 for upper CE and 0.85 to 0.86 for lower CE. In addition, the results allowed to note a significant positive correlation between thoracic mobility measurements and spirometric variables, and a particularly strong correlation with FEV₁/FVC (r = 0.68). Also, in the study by Derasse et al. [ 19 ] conducted on 251 individuals, the relationship was analysed between chest expansion measurements and lung function parameters such as TLC, FVC, and FEV₁. A significant but weak correlation was found between chest expansion measurements and all lung function parameters (p = 0.01). The present study is the first in which the correlation was assessed between thoracic and diaphragmatic mobility. It was revealed that with the increase in the amplitude of the movements performed by the diaphragm, the amplitude of thoracic mobility also increased. The mean amplitude of the diaphragm mobility in the study group was 1.79 ± 0.63 cm, while the mean difference in chest circumferences, calculated as the average value of the three measurement levels (axilla, mastoid bone line, xiphoid process), was 2.60 ± 1.14 cm. Statistically significant positive correlations were observed between these variables, with the strongest relationship noted between the amplitude of the diaphragm mobility and the difference in the chest circumference at the axillary level (r = 0.53). This relationship is classified as a strong positive correlation and indicates that with the increase in the amplitude of the diaphragm mobility, the range of chest expansion at this level also increases. Traditionally, it is believed that the upper part of the thorax (axillary level) is mainly engaged by the accessory respiratory muscles. Meanwhile, the results of the current study allow to suggest that diaphragmatic mobility may also indirectly affect the expansion of the upper thorax. In the authors’ opinion, the upper segments of the thorax may also be involved in the process of generating negative intrathoracic pressure. Confirmation of this phenomenon can be found in the work by Aliverti et al. [ 20 ]. These authors, using optoelectronic plethysmography, demonstrated that diaphragmatic mobility significantly affects volumetric changes in the lower thoracic segments, which mechanically affect the entire structure of the thorax, including its upper parts. In the case of the mastoid and the xiphoid process levels, a moderate (r = 0.36) and weak (r = 0.22) positive correlation (respectively) was observed with regard to the amplitude of diaphragm mobility. These results can be interpreted as an expression of lower anatomical correlation or a greater influence of local factors such as abdominal muscle tension. Similar conclusions can be found in the study by Yang et al. [ 21 ], in which the mobility of the diaphragm and chest wall was examined using dynamic MRI in individuals with normal lung function. The authors found that the mobility of the chest wall is different depending on the thoracic segment. In the present research, all correlation coefficients were positive, which confirms the hypothesis that increased diaphragmatic mobility translates into increased thoracic mobility. The obtained data also indicate that the amplitudes of thoracic mobility are not identical either in terms of the size or location of the dominant mobility. This allows to suggest some differentiation of respiratory mechanics depending on the thoracic segment and individual anatomical features of the studied participants. According to many authors, gender, age, and body mass index are parameters that can affect chest expansion. Among others, in the study by Kushwaha et al. [ 7 ], it was indicated that the difference in the mean chest expansion at all three levels among men was higher in males compared to females. The results of the current trial revealed that gender was not a factor differentiating diaphragmatic or thoracic range of motion. The results obtained by Darasse et al. [ 19 ] are in agreement with those obtained in the present study, noting that the upper and lower chest expansion did not differ between males and females. The analysis showed that age can have a significant effect on both the mobility of the diaphragm and the thorax. For the amplitude of the diaphragmatic mobility, we noted a strong negative correlation (r = -0.55), and for the thoracic region, depending on the measurement level, from − 0.34 to -0.43. This means that the mobility of the chest and the diaphragm decreases with age. This may be caused by age-related changes in the musculoskeletal structures and connective tissue, such as: reduced elasticity of the ribs and sternocostal joints as well as weakening of respiratory muscle strength. The results achieved by the authors of the present study are consistent with those obtained by other authors, including Kushwaha [ 7 ] and Adachi [ 22 ]. The results of correlation analysis between BMI and the examined variables were also negative. The highest correlation coefficient (r = − 0.43) was between BMI and chest mobility at the mastoid level. With regard to diaphragmatic mobility, the correlation coefficient was − 0.19, which means a weak but also negative relationship. These results may indicate that individuals with a higher BMI show some limitations in the expansion of the chest walls, which may be the result of increased abdominal wall tension and/or intraabdominal pressure or accumulation of fat tissue in the abdominal and chest cavity. This was not confirmed in the study by Bataweel et al. [ 23 ], who examined 90 children aged 6 to 11 years, divided into two groups, 47 normal weight and 43 obese. One of the examinations regarded chest expansion testing. The result of this test revealed no statistically significant differences between the groups. There are few existing studies in which the effect of age and body mass on diaphragmatic mobility is assessed. An example of such research is the work by Zhang et al. [ 24 ]. These authors studied 212 individuals, assessing the thickness and mobility of the diaphragm. Their results indicate that the amplitude of its mobility decreases with age and greater body mass, which is consistent with the results obtained in this work. Limitations There were a number of potential limitations noted in this study. They include the small sample size, which, although sufficient for statistical analysis, restricts the ability to generalise the results to a broader population. A significant substantive limitation is the limited number of studies directly analysing correlations between diaphragmatic mobility amplitude and thoracic mobility in healthy individuals. The majority of available studies focus on measuring either diaphragmatic or thoracic mobility separately or include clinical groups (e.g. patients with COPD). For this reason, the presented results partially fill the research gap, but require further verification and further investigation in larger samples. The relatively small sample size also reflects the exploratory and physiological nature of the study and should be interpreted as proof-of-concept data rather than definitive normative values. Conclusions Based on the conducted studies, a significant positive correlation has been demonstrated between the amplitude of diaphragmatic mobility and thoracic expansion, which confirms their functional interaction in respiratory mechanics. Declarations Ethics approval and consent to participate The study was conducted in accordance with the principles of the Declaration of Helsinki. Conflicts of Interest The authors declare no conflicts of interest. Funding This research received no external funding. Author Contribution T.W. contributed to study methodology and wrote the original draft of the manuscript, as well as reviewed and edited the final version. A.O. contributed to data collection and wrote parts of the original draft. M.G. contributed to data acquisition and analysis and wrote parts of the original draft. J.M. and S.N. contributed to software development, methodology, and formal analysis. E.S. contributed to study conceptualization and critically reviewed and edited the manuscript. All authors reviewed and approved the final version of the manuscript. Data Availability The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. References Portacci A, Iorillo I, Quaranta VN, Amendolara M, Sana F, Pezzuto V, Ferrulli S, Dragonieri S, Carpagnano GE. Diaphragm function in patients with asthma and healthy controls: A cross-sectional study. Respir Med. 2025;239:108008. 10.1016/j.rmed.2025.108008 . Cuenca-Martínez F, Sempere-Rubio N, Muñoz-Gómez E, Mollà-Casanova S, Carrasco-González E, Martínez-Arnau FM. Respiratory Function Analysis in Patients with Chronic Pain: An Umbrella Review and Meta-Analysis of Pooled Findings. 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Ann Saudi Med. 2020 Mar–Apr;40(2):120–5. 10.5144/0256-4947.2020.120 . Zhang T, Liu Y, Xu D, Dong R, Song Y. Diaphragm Assessment by Multimodal Ultrasound Imaging in Healthy Subjects. Int J Gen Med. 2024;17:4015–24. 10.2147/IJGM.S478136 . Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Revision Version 1 posted Editorial decision: Revision requested 09 Mar, 2026 Reviews received at journal 08 Mar, 2026 Reviews received at journal 25 Feb, 2026 Reviewers agreed at journal 09 Feb, 2026 Reviewers agreed at journal 09 Feb, 2026 Reviewers invited by journal 22 Jan, 2026 Editor assigned by journal 21 Jan, 2026 Editor invited by journal 08 Jan, 2026 Submission checks completed at journal 07 Jan, 2026 First submitted to journal 07 Jan, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8511981","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":580756254,"identity":"369c4acf-ab35-4183-b445-40b8eb04ce47","order_by":0,"name":"Tomasz Wloch","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAkElEQVRIiWNgGAWjYFAC5gYGxgYbEIvxAFEaeIDqgSgNzCFJy2EStNhLJDY++LnjfOJ2Bt4DRNoikdhs2HvmduLOBr4EIrVIJ7ZJM7bdzt1wgMeAJC3nSNdygBQt9x8C/dKWXL+zmVi/sPccPvjgZ5udsTl778EHRGmBAwNmHtI0ALUwkKxlFIyCUTAKRgoAAJ9RMuvwW+tDAAAAAElFTkSuQmCC","orcid":"","institution":"University of Physical Culture","correspondingAuthor":true,"prefix":"","firstName":"Tomasz","middleName":"","lastName":"Wloch","suffix":""},{"id":580756255,"identity":"8ba71d0a-926d-4605-9f61-ef19a4a3368e","order_by":1,"name":"Anna Olbrych","email":"","orcid":"","institution":"Edmund Wojtyła Małopolska Hospital of Lung Diseases and Rehabilitation in Jaroszowiec","correspondingAuthor":false,"prefix":"","firstName":"Anna","middleName":"","lastName":"Olbrych","suffix":""},{"id":580756256,"identity":"b44a4522-617d-42e1-9544-31aabfffd37f","order_by":2,"name":"Mateusz Groszyk","email":"","orcid":"","institution":"University of Physical Culture","correspondingAuthor":false,"prefix":"","firstName":"Mateusz","middleName":"","lastName":"Groszyk","suffix":""},{"id":580756257,"identity":"c6c96589-91c5-4ce5-8bc7-0d3ffa02f4fe","order_by":3,"name":"Jakub Marchewka","email":"","orcid":"","institution":"University of Physical Culture","correspondingAuthor":false,"prefix":"","firstName":"Jakub","middleName":"","lastName":"Marchewka","suffix":""},{"id":580756258,"identity":"ba5c5897-7eec-4d59-9527-a55aecc76adc","order_by":4,"name":"Sebastian Nowak","email":"","orcid":"","institution":"5th Military Hospital with Polyclinic","correspondingAuthor":false,"prefix":"","firstName":"Sebastian","middleName":"","lastName":"Nowak","suffix":""},{"id":580756259,"identity":"e5db69b2-2738-418a-8e7c-3fea6f992a19","order_by":5,"name":"Elżbieta Szczygieł","email":"","orcid":"","institution":"University of Physical Culture","correspondingAuthor":false,"prefix":"","firstName":"Elżbieta","middleName":"","lastName":"Szczygieł","suffix":""}],"badges":[],"createdAt":"2026-01-04 09:38:13","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8511981/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8511981/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":101245521,"identity":"d4b61cfc-f180-4330-b913-49b4220e5746","added_by":"auto","created_at":"2026-01-27 16:32:08","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":28148,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eAssessment of diaphragmatic mobility via ultrasound [authors’ source].\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"Figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8511981/v1/d13fe9bc35184b0ab74f8bc8.jpg"},{"id":101880406,"identity":"752e7012-e53c-4e8c-a0f0-9dec2761080c","added_by":"auto","created_at":"2026-02-04 14:59:50","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":856763,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8511981/v1/8d9d4143-b15a-401e-9e4d-d75f03d0b7ee.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Assessment of Correlations Between Amplitude of Thoracic and Diaphragmatic Mobility in Healthy Adults","fulltext":[{"header":"Introduction","content":"\u003cp\u003eA properly functioning respiratory system is one of the basic mechanisms ensuring proper functioning of the body. Respiratory efficiency depends on both internal factors, i.e. those related to the lungs and bronchi, and external ones regarding respiratory mobility of the chest. In thoracic mobility, two main phases of breathing can be distinguished: inhalation and exhalation. Inhalation is associated with the increase in chest volume, while exhalation concerns its decrease. During inhalation, the diaphragm, which is the main respiratory muscle, contracts. This causes an increase in the longitudinal dimension and a decrease in the pressure in the chest (negative pressure is created). An increase in the upper-lower dimension is not the only change that occurs due to contraction of the diaphragm. The shape of the chest also changes and the ribs move. Thanks to the external intercostal muscles, the sternum is raised and the ribs are lifted which, in turn, causes the chest to widen and deepen. In a correct breathing pattern, the chest and abdominal cavity are simultaneously activated.\u003c/p\u003e \u003cp\u003eThe interaction of these structures enables proper gas exchange and adaptation of the respiratory system to changing physiological loads. Limiting their mobility can lead to respiratory dysfunctions and is associated with assuming a compensatory breathing pattern. Dysfunctional breathing patterns have been documented in patients with asthma [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e], chronic back and neck pain [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e], circulatory system diseases [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e], anxiety and depression [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe study of breathing mechanics is an important element of diagnostics. There are a number of methods used for measuring thoracic mobility, from those very simple and undemanding to ones that are expensive and complicated, such as optoelectronic plethysmography, respiratory inductive plethysmography or photogrammetry [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Despite their non-invasiveness and high measurement accuracy, these methods require the use of expensive, specialist devices, which is why they are not very popular and are rather a subject of interest in research centres. Undoubtedly, one of the simplest methods is to measure chest circumference with a tape measure. Such a technique is used both in clinical practice and for scientific purposes. In turn, ultrasonography is applied in the assessment of diaphragm function [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. This method is gaining increasing recognition due to its availability, safety and high diagnostic value.\u003c/p\u003e\n\u003ch3\u003eObjective\u003c/h3\u003e\n\u003cp\u003eTaking the interdependence of the diaphragmatic and thoracic mobility into account, the aim of the presented study was to assess correlations between chest and diaphragmatic mobility.\u003c/p\u003e"},{"header":"Material and methods","content":"\u003cp\u003eThe study involved 30 individuals, including 17 men and 13 women aged 28 to 69 years (42.37\u0026thinsp;\u0026plusmn;\u0026thinsp;7.36 years) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). These participants were completely healthy, recruited from the general population, in whom respiratory problems, chest deformities and postural defects were excluded. The research was conducted in controlled conditions, with uniform measurement procedures for all participants. Consent to conduct the study was obtained from the Bioethical Committee (No. 126/KBL/OIL/2023) at the District Medical Chamber in Krak\u0026oacute;w. Written informed consent was obtained from all participants prior to participation in the study.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCharacteristics of the study group\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"10\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003eWomen\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c10\" namest=\"c8\"\u003e \u003cp\u003eMen\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;\u003cem\u003eSD\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMin\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMax\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;\u003cem\u003eSD\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMin\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eMax\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;\u003cem\u003eSD\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eMin\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003eMax\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge [years]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e46.70\u0026thinsp;\u0026plusmn;\u0026thinsp;11.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e43.38\u0026thinsp;\u0026plusmn;\u0026thinsp;10.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c8\"\u003e \u003cp\u003e49.23\u0026thinsp;\u0026plusmn;\u0026thinsp;10.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e69\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBody mass [kg]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e78.53\u0026thinsp;\u0026plusmn;\u0026thinsp;13.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e109\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e71.84\u0026thinsp;\u0026plusmn;\u0026thinsp;12.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c8\"\u003e \u003cp\u003e83.65\u0026thinsp;\u0026plusmn;\u0026thinsp;15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e109\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBody height [cm]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e170.27\u0026thinsp;\u0026plusmn;\u0026thinsp;8.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e155\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e191\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e163.92\u0026thinsp;\u0026plusmn;\u0026thinsp;5.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e155\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e174\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c8\"\u003e \u003cp\u003e172.12\u0026thinsp;\u0026plusmn;\u0026thinsp;6.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e165\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e191\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI [kg/m\u0026sup2;]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e27.02\u0026thinsp;\u0026plusmn;\u0026thinsp;3.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e35.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e26.68\u0026thinsp;\u0026plusmn;\u0026thinsp;3.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e20.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e33.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c8\"\u003e \u003cp\u003e27.27\u0026thinsp;\u0026plusmn;\u0026thinsp;4.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e20.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e35.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"10\"\u003e\u003cem\u003eSD\u003c/em\u003e \u0026ndash; standard deviation; Min \u0026ndash; minimum measurement obtained; Max \u0026ndash; maximum measurement obtained; BMI \u0026ndash; Body Mass Index\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\n\u003ch3\u003eMeasurement of thoracic mobility using measuring tape (in cm)\u003c/h3\u003e\n\u003cp\u003eDuring the study, two chest circumference measurements were taken: during maximum inhalation and maximum exhalation, and the difference between them was considered the amplitude of thoracic mobility at this level. In further analysis, the average mobility for the chest was also calculated. In accordance with recommendations found in literature on the subject, measurements were taken in free standing position, at three levels: at the height of the underarms (axillary level), at the mastoid line and at the level of the xiphoid process. The axillary measurement was taken with the arms raised above the head, while the remaining measurements were performed with the arms lowered [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e\n\u003ch3\u003eAssessment of diaphragmatic mobility\u003c/h3\u003e\n\u003cp\u003eThe measurement of diaphragm mobility was performed using the Mindray ultrasound scanner using a convex transducer and the M-mode imaging setting. During the measurement, the patients were in the supine position with their lower limbs flexed at the hips and knees, their hands behind their heads. The liver was used as an acoustic window for subcostal projection. The transducer was positioned in the midclavicular line, directed cranially to make the diaphragm dome as visible as possible. In the image, the diaphragm dome can be seen as a distinct hyperechoic line located at the bottom of the screen. During respiration, this line assumes a sinusoidal shape, where the upward deflection corresponds to inhalation (the diaphragm dome moves towards the front of the transducer) and the downward deflection corresponds to exhalation. Depth measurement can be obtained on the M-mode image by marking the depth difference between the peak of inhalation and exhalation.\u003c/p\u003e\n\u003ch3\u003eMethods of statistical analysis\u003c/h3\u003e\n\u003cp\u003eDescriptive analysis and the Shapiro-Wilk test were used to assess the normality of data distribution. For data with normal distribution, the Student's \u003cem\u003et\u003c/em\u003e-test and Pearson's correlation coefficient were used. For non-normally distributed data, the Mann-Whitney test and Spearman's correlation coefficient were applied. The level of statistical significance was assumed at the level of \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003cp\u003eThe minimum, maximum, arithmetic mean and standard deviation were calculated for the age, body mass and height, BMI, difference in circumference at the axilla, mastoid line, xiphoid process and diaphragm amplitude as well as the mean difference in chest circumference of the subjects.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe measurements of thoracic mobility performed at three different levels and the measurements of diaphragmatic mobility using ultrasound are presented in Tables\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e (for the whole group) and 3 (divided according to gender). No significant differences were observed between the results obtained for women and men (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eObtained results for thoracic mobility in the whole group (n\u0026thinsp;=\u0026thinsp;30)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;\u003cem\u003eSD\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMin\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMax\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInhalation \u0026ndash; at axilla level [cm]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e98.77\u0026thinsp;\u0026plusmn;\u0026thinsp;9.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e113\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExhalation \u0026ndash; at axilla level [cm]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e96.05\u0026thinsp;\u0026plusmn;\u0026thinsp;9.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e110\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCircumference difference at axilla level [cm]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e2.72\u0026thinsp;\u0026plusmn;\u0026thinsp;1.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInhalation \u0026ndash; at mastoid level [cm]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e102.47\u0026thinsp;\u0026plusmn;\u0026thinsp;9.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e118\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExhalation \u0026ndash; at mastoid level [cm]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e99.8\u0026thinsp;\u0026plusmn;\u0026thinsp;9.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e116\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCircumference difference at mastoid level [cm]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e2.67\u0026thinsp;\u0026plusmn;\u0026thinsp;1.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInhalation \u0026ndash; at xiphoid process level [cm]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e94.30\u0026thinsp;\u0026plusmn;\u0026thinsp;10.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e112\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExhalation \u0026ndash; at xiphoid process level [cm]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e91.88\u0026thinsp;\u0026plusmn;\u0026thinsp;10.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e111\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCircumference difference at xiphoid process level [cm]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e2.42\u0026thinsp;\u0026plusmn;\u0026thinsp;1.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-2.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean difference in chest circumference [cm]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e2.60\u0026thinsp;\u0026plusmn;\u0026thinsp;1.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.33\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAmplitude of diaphragmatic mobility [cm]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e1.79\u0026thinsp;\u0026plusmn;\u0026thinsp;0.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.03\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003cem\u003eSD\u003c/em\u003e \u0026ndash; standard deviation; Min \u0026ndash; minimum obtained measurement; Max \u0026ndash; maximum obtained measurement\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eObtained results for thoracic mobility according to gender\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eWomen (n\u0026thinsp;=\u0026thinsp;13)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003eMen (n\u0026thinsp;=\u0026thinsp;17)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean \u0026plusmn; \u003cem\u003eSD\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMin\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMax\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;\u003cem\u003eSD\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMin\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eMax\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInhalation \u0026ndash; at axilla level [cm]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e92.73\u0026thinsp;\u0026plusmn;\u0026thinsp;9.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e111\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e103.38\u0026thinsp;\u0026plusmn;\u0026thinsp;6.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e113\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExhalation \u0026ndash; at axilla level [cm]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e89.88\u0026thinsp;\u0026plusmn;\u0026thinsp;8.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e107\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e100.76\u0026thinsp;\u0026plusmn;\u0026thinsp;6.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e110\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCircumference difference\u003c/p\u003e \u003cp\u003eat axilla level [cm]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e2.85\u0026thinsp;\u0026plusmn;\u0026thinsp;0.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e2.62\u0026thinsp;\u0026plusmn;\u0026thinsp;1.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInhalation \u0026ndash; at mastoid level [cm]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e99.85\u0026thinsp;\u0026plusmn;\u0026thinsp;11.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e118\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e104.47\u0026thinsp;\u0026plusmn;\u0026thinsp;6.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e117\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExhalation \u0026ndash; at mastoid level [cm]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e96.92\u0026thinsp;\u0026plusmn;\u0026thinsp;11.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e115\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e102.00\u0026thinsp;\u0026plusmn;\u0026thinsp;7.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e116\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCircumference difference at mastoid level [cm]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e2.92\u0026thinsp;\u0026plusmn;\u0026thinsp;1.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e2.47\u0026thinsp;\u0026plusmn;\u0026thinsp;1.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInhalation \u0026ndash; at xiphoid process level [cm]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e86.77\u0026thinsp;\u0026plusmn;\u0026thinsp;8.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e100.06\u0026thinsp;\u0026plusmn;\u0026thinsp;7.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e112\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExhalation \u0026ndash; at xiphoid process level [cm]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e84.81\u0026thinsp;\u0026plusmn;\u0026thinsp;8.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e97.29\u0026thinsp;\u0026plusmn;\u0026thinsp;8.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e111\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCircumference difference at xiphoid process level [cm]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e1.96\u0026thinsp;\u0026plusmn;\u0026thinsp;1.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e2.76\u0026thinsp;\u0026plusmn;\u0026thinsp;1.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean difference in chest circumference [cm]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e2.58\u0026thinsp;\u0026plusmn;\u0026thinsp;0.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e2.62\u0026thinsp;\u0026plusmn;\u0026thinsp;1.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e5.33\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAmplitude of diaphragmatic mobility [cm]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e1.82\u0026thinsp;\u0026plusmn;\u0026thinsp;0.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e1.76\u0026thinsp;\u0026plusmn;\u0026thinsp;0.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3.03\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003e\u003cem\u003eSD\u003c/em\u003e \u0026ndash; standard deviation; Min \u0026ndash; minimum obtained measurement; Max \u0026ndash; maximum obtained measurement\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eIt was found that the distribution of age, BMI, diaphragm mobility amplitude and the difference in chest circumference at the height of the axilla, mastoid bone, xiphoid process and the mean for the chest is normal, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05. Therefore, Pearson\u0026rsquo;s correlation coefficient was calculated between these variables. The distribution of results for the difference in circumference at the height of the axilla was not normal, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05, thus, its correlations with other variables were calculated using Spearman\u0026rsquo;s correlation coefficient. Correlations were calculated between age and BMI, and the differences in measurements of circumference at the height of the axilla, mastoid, xiphoid process and the mean difference in measurements for the chest. These results are presented in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCorrelation coefficients between age, BMI and difference in conducted measurements\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAmplitude of diaphragmatic mobility [cm]\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c6\" namest=\"c3\"\u003e \u003cp\u003eThoracic mobility\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDiaphragm\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAxilla level\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMastoid level\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eXiphoid process\u003c/p\u003e \u003cp\u003elevel\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMean difference of chest circumference\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-0.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e-0.43\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBMI\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-0.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e-0.27\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eBMI \u0026ndash; Body Mass Index\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAccording to the data presented in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e, negative correlation coefficients were found between age and BMI and the amplitude of diaphragm mobility, as well as chest mobility at its various levels (axillae, mastoid, xiphoid process, mean difference).\u003c/p\u003e \u003cp\u003eThe strongest correlation was observed between age and the amplitude of diaphragmatic mobility (r = -0.55), which means a strong negative relationship \u0026ndash; along with the increase in the age of the subjects, the amplitude of diaphragmatic mobility clearly decreased. In the case of the remaining measurements (chest), the correlations ranged from \u0026minus;\u0026thinsp;0.15 to -0.43, which was interpreted as weak or moderate relationships.\u003c/p\u003e \u003cp\u003eIn turn, the correlation values ​​between BMI and mobility amplitude were also negative, with the strongest relationship being noted in the measurement of chest mobility at the mastoid level (r = -0.43). These results allow to suggest that greater body mass may limit both diaphragmatic mobility and thoracic expansion during inhalation.\u003c/p\u003e \u003cp\u003eCorrelation coefficients were also calculated between the amplitude of diaphragm mobility and the differences in measurements of circumference at the axilla, mastoid, xiphoid process, and the mean difference in measurements for the chest. The results are presented in Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCorrelation coefficients between amplitude of diaphragmatic mobility and the differences in circumference measurements at the level of the axilla, mastoid, xiphoid process and the mean difference in measurements of the chest\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003eThoracic mobility\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eAxilla level\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eMastoid level\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eXiphoid process\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003elevel\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003eMean difference of chest circumference\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDiaphragm\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.43\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eCorrelation strength was interpreted as: r\u0026thinsp;\u0026ge;\u0026thinsp;0.5 strong, 0.3\u0026ndash;0.49 moderate, \u0026lt;\u0026thinsp;0.3 weak.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe coefficients calculated for the amplitude of diaphragmatic mobility and the differences in circumference measurements at the remaining heights are positive, which means that the higher the measured amplitude of the diaphragm, the larger the remaining circumferences (amplitude of thoracic mobility). The correlation between the difference in the measurements of diaphragm amplitude and the mobility of the chest at the axilla level is particularly strong \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.5 (r\u0026thinsp;=\u0026thinsp;0.53), which \u0026ndash; according to the adopted classification of the dependence strength \u0026ndash; means a strong statistical relationship. The correlations for the mobility of the chest at the level of the mastoid bone (r\u0026thinsp;=\u0026thinsp;0.36) and xiphoid process (r\u0026thinsp;=\u0026thinsp;0.22) also demonstrate relationships \u0026mdash; moderate and weak, respectively.\u003c/p\u003e \u003cp\u003eConfirmation of this relationship indicates that individuals with greater diaphragm mobility also exhibit increased thoracic mobility, which confirms the functional cooperation of both respiratory mechanisms.\u003c/p\u003e \u003cp\u003eThere was no significant difference between the results for women and men, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05. Men were not found to demonstrate significantly greater diaphragmatic mobility, nor were women noted to show greater thoracic mobility.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe chest is an effective respiratory pump that moves in response to the coordinated actions of the diaphragm and intercostal muscles. Mobility restriction in one of these structures can significantly affect the function of the other, leading to an increase in the work of breathing. The results of the study by Saeed et al. [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e] allow to indicate that pulmonary rehabilitation, including rib cage mobilisation and diaphragm strengthening exercises, significantly improves the cooperation of these structures and increases maximum respiratory pressures.\u003c/p\u003e \u003cp\u003eThe examination of both thoracic and diaphragmatic mobility is essential for assessing breathing patterns. A simple and inexpensive tool for measuring chest expansion is a measuring tape. Using it, the chest circumference is measured during maximum inhalation and maximum exhalation at specific levels. In a study by Bockenhauer [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] on the reliability of thoracic mobility measurements using a centimetre (tailor's) tape, high repeatability was shown of this method (ICC 0.99). For that reason, it has been used in many studies [\u003cspan additionalcitationids=\"CR11\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eUltrasonography has been applied in the assessment of the diaphragm, which is a non-invasive, safe and repeatable method for measuring its thickness and mobility. Due to its advantages, it is a standard in the study of respiratory mechanics [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. It is implemented to evaluate its mobility in various disease states [\u003cspan additionalcitationids=\"CR16\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDue to the multitude of methods used in assessing lung function and chest mobility, the task of science is to assess the correlation of results obtained using these methods. The work by Reddy et al. [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] fits into the trend of such searches, in which the authors assessed both the reliability of thoracic mobility measurements using a measuring tape (cm) and their correlations with spirometric parameters such as FEV₁, FVC and FEV₁/FVC. The intrarater reliability for upper and lower CE (chest expansion) showed very good agreement with intraclass correlation (ICC) values between 0.90 and 0.93 for upper CE and 0.85 to 0.86 for lower CE. In addition, the results allowed to note a significant positive correlation between thoracic mobility measurements and spirometric variables, and a particularly strong correlation with FEV₁/FVC (r\u0026thinsp;=\u0026thinsp;0.68). Also, in the study by Derasse et al. [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] conducted on 251 individuals, the relationship was analysed between chest expansion measurements and lung function parameters such as TLC, FVC, and FEV₁. A significant but weak correlation was found between chest expansion measurements and all lung function parameters (p\u0026thinsp;=\u0026thinsp;0.01).\u003c/p\u003e \u003cp\u003eThe present study is the first in which the correlation was assessed between thoracic and diaphragmatic mobility. It was revealed that with the increase in the amplitude of the movements performed by the diaphragm, the amplitude of thoracic mobility also increased. The mean amplitude of the diaphragm mobility in the study group was 1.79\u0026thinsp;\u0026plusmn;\u0026thinsp;0.63 cm, while the mean difference in chest circumferences, calculated as the average value of the three measurement levels (axilla, mastoid bone line, xiphoid process), was 2.60\u0026thinsp;\u0026plusmn;\u0026thinsp;1.14 cm. Statistically significant positive correlations were observed between these variables, with the strongest relationship noted between the amplitude of the diaphragm mobility and the difference in the chest circumference at the axillary level (r\u0026thinsp;=\u0026thinsp;0.53). This relationship is classified as a strong positive correlation and indicates that with the increase in the amplitude of the diaphragm mobility, the range of chest expansion at this level also increases. Traditionally, it is believed that the upper part of the thorax (axillary level) is mainly engaged by the accessory respiratory muscles. Meanwhile, the results of the current study allow to suggest that diaphragmatic mobility may also indirectly affect the expansion of the upper thorax. In the authors\u0026rsquo; opinion, the upper segments of the thorax may also be involved in the process of generating negative intrathoracic pressure. Confirmation of this phenomenon can be found in the work by Aliverti et al. [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. These authors, using optoelectronic plethysmography, demonstrated that diaphragmatic mobility significantly affects volumetric changes in the lower thoracic segments, which mechanically affect the entire structure of the thorax, including its upper parts.\u003c/p\u003e \u003cp\u003eIn the case of the mastoid and the xiphoid process levels, a moderate (r\u0026thinsp;=\u0026thinsp;0.36) and weak (r\u0026thinsp;=\u0026thinsp;0.22) positive correlation (respectively) was observed with regard to the amplitude of diaphragm mobility. These results can be interpreted as an expression of lower anatomical correlation or a greater influence of local factors such as abdominal muscle tension. Similar conclusions can be found in the study by Yang et al. [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e], in which the mobility of the diaphragm and chest wall was examined using dynamic MRI in individuals with normal lung function. The authors found that the mobility of the chest wall is different depending on the thoracic segment.\u003c/p\u003e \u003cp\u003eIn the present research, all correlation coefficients were positive, which confirms the hypothesis that increased diaphragmatic mobility translates into increased thoracic mobility. The obtained data also indicate that the amplitudes of thoracic mobility are not identical either in terms of the size or location of the dominant mobility. This allows to suggest some differentiation of respiratory mechanics depending on the thoracic segment and individual anatomical features of the studied participants.\u003c/p\u003e \u003cp\u003eAccording to many authors, gender, age, and body mass index are parameters that can affect chest expansion. Among others, in the study by Kushwaha et al. [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], it was indicated that the difference in the mean chest expansion at all three levels among men was higher in males compared to females. The results of the current trial revealed that gender was not a factor differentiating diaphragmatic or thoracic range of motion. The results obtained by Darasse et al. [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] are in agreement with those obtained in the present study, noting that the upper and lower chest expansion did not differ between males and females.\u003c/p\u003e \u003cp\u003eThe analysis showed that age can have a significant effect on both the mobility of the diaphragm and the thorax. For the amplitude of the diaphragmatic mobility, we noted a strong negative correlation (r = -0.55), and for the thoracic region, depending on the measurement level, from \u0026minus;\u0026thinsp;0.34 to -0.43. This means that the mobility of the chest and the diaphragm decreases with age. This may be caused by age-related changes in the musculoskeletal structures and connective tissue, such as: reduced elasticity of the ribs and sternocostal joints as well as weakening of respiratory muscle strength. The results achieved by the authors of the present study are consistent with those obtained by other authors, including Kushwaha [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] and Adachi [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe results of correlation analysis between BMI and the examined variables were also negative. The highest correlation coefficient (r = \u0026minus;\u0026thinsp;0.43) was between BMI and chest mobility at the mastoid level. With regard to diaphragmatic mobility, the correlation coefficient was \u0026minus;\u0026thinsp;0.19, which means a weak but also negative relationship. These results may indicate that individuals with a higher BMI show some limitations in the expansion of the chest walls, which may be the result of increased abdominal wall tension and/or intraabdominal pressure or accumulation of fat tissue in the abdominal and chest cavity. This was not confirmed in the study by Bataweel et al. [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e], who examined 90 children aged 6 to 11 years, divided into two groups, 47 normal weight and 43 obese. One of the examinations regarded chest expansion testing. The result of this test revealed no statistically significant differences between the groups. There are few existing studies in which the effect of age and body mass on diaphragmatic mobility is assessed. An example of such research is the work by Zhang et al. [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. These authors studied 212 individuals, assessing the thickness and mobility of the diaphragm. Their results indicate that the amplitude of its mobility decreases with age and greater body mass, which is consistent with the results obtained in this work.\u003c/p\u003e\n\u003ch3\u003eLimitations\u003c/h3\u003e\n\u003cp\u003eThere were a number of potential limitations noted in this study. They include the small sample size, which, although sufficient for statistical analysis, restricts the ability to generalise the results to a broader population. A significant substantive limitation is the limited number of studies directly analysing correlations between diaphragmatic mobility amplitude and thoracic mobility in healthy individuals. The majority of available studies focus on measuring either diaphragmatic or thoracic mobility separately or include clinical groups (e.g. patients with COPD). For this reason, the presented results partially fill the research gap, but require further verification and further investigation in larger samples. The relatively small sample size also reflects the exploratory and physiological nature of the study and should be interpreted as proof-of-concept data rather than definitive normative values.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eBased on the conducted studies, a significant positive correlation has been demonstrated between the amplitude of diaphragmatic mobility and thoracic expansion, which confirms their functional interaction in respiratory mechanics.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eEthics approval and consent to participate\u003c/h2\u003e \u003cp\u003e The study was conducted in accordance with the principles of the Declaration of Helsinki.\u003c/p\u003e\u003ch2\u003eConflicts of Interest\u003c/h2\u003e \u003cp\u003eThe authors declare no conflicts of interest.\u003c/p\u003e \u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThis research received no external funding.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eT.W. contributed to study methodology and wrote the original draft of the manuscript, as well as reviewed and edited the final version. A.O. contributed to data collection and wrote parts of the original draft. M.G. contributed to data acquisition and analysis and wrote parts of the original draft. J.M. and S.N. contributed to software development, methodology, and formal analysis. E.S. contributed to study conceptualization and critically reviewed and edited the manuscript. All authors reviewed and approved the final version of the manuscript.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003ePortacci A, Iorillo I, Quaranta VN, Amendolara M, Sana F, Pezzuto V, Ferrulli S, Dragonieri S, Carpagnano GE. Diaphragm function in patients with asthma and healthy controls: A cross-sectional study. 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Int J Gen Med. 2024;17:4015\u0026ndash;24. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.2147/IJGM.S478136\u003c/span\u003e\u003cspan address=\"10.2147/IJGM.S478136\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-pulmonary-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pulm","sideBox":"Learn more about [BMC Pulmonary Medicine](http://bmcpulmmed.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pulm/default.aspx","title":"BMC Pulmonary Medicine","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"ultrasound, respiratory mechanics, thoracic mobility, diaphragm mobility","lastPublishedDoi":"10.21203/rs.3.rs-8511981/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8511981/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eIntroduction:\u003c/h2\u003e \u003cp\u003eThoracic and diaphragmatic mobility are key components of respiratory mechanics and jointly contribute to effective ventilation. Simple clinical tools, such as tape-based chest expansion measurements and ultrasound assessment of diaphragmatic excursion, are increasingly used in respiratory and physiotherapy practice. However, the physiological relationship between thoracic and diaphragmatic mobility assessed using these methods has not been sufficiently explored.\u003c/p\u003e\u003ch2\u003eObjectives\u003c/h2\u003e \u003cp\u003eThis study aimed to investigate the association between thoracic mobility measured at different chest levels and diaphragmatic mobility assessed using ultrasonography in healthy adults.\u003c/p\u003e\u003ch2\u003eMaterial and methods\u003c/h2\u003e \u003cp\u003eThirty healthy adults participated in this cross-sectional study. Thoracic mobility was assessed using tape measurements during maximal inspiration and expiration at three levels: axillary, sternal, and xiphoid. Diaphragmatic mobility was evaluated as diaphragmatic excursion using M-mode ultrasonography.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eSignificant positive correlations were observed between diaphragmatic excursion and thoracic mobility at all measured chest levels, with the strongest association at the axillary level (r\u0026thinsp;=\u0026thinsp;0.53). Age and BMI were negatively associated with both diaphragmatic and thoracic mobility, while no significant sex-related differences were observed.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThese findings support the concept of functional coupling between thoracic and diaphragmatic components of respiratory mechanics.\u003c/p\u003e","manuscriptTitle":"Assessment of Correlations Between Amplitude of Thoracic and Diaphragmatic Mobility in Healthy Adults","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-27 16:32:03","doi":"10.21203/rs.3.rs-8511981/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-03-09T06:33:04+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-08T07:18:31+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-25T21:29:57+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"204051931765198316559242716281106725382","date":"2026-02-10T01:26:38+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"71814022192893304840641000049348790054","date":"2026-02-09T20:10:23+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-01-22T12:29:12+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-01-22T01:38:46+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-01-08T08:39:42+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-01-07T21:59:44+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pulmonary Medicine","date":"2026-01-07T21:52:49+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pulmonary-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pulm","sideBox":"Learn more about [BMC Pulmonary Medicine](http://bmcpulmmed.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pulm/default.aspx","title":"BMC Pulmonary Medicine","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"6b5a344c-e87e-4220-ba53-dfba88b4324e","owner":[],"postedDate":"January 27th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[],"tags":[],"updatedAt":"2026-03-09T06:40:54+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-27 16:32:03","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8511981","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8511981","identity":"rs-8511981","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}