Predictive equations for ventilatory muscle strength in the Brazilian population: a systematic review

Silva, Glória de Paula; Bunn, Priscila dos Santos; Sodré, Ravini de Souza; Pinto, Daianny França; Silva, Elirez Bezerra da

doi:10.1590/1809-2950/20012028042021

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SYSTEMATIC REVIEW • Fisioter. Pesqui. 28 (4) • Oct-Dec 2021 • https://doi.org/10.1590/1809-2950/20012028042021 copy

Predictive equations for ventilatory muscle strength in the Brazilian population: a systematic review

Equações preditivas da força muscular ventilatória na população brasileira: uma revisão sistemática

Ecuaciones predictivas de la fuerza muscular respiratoria en la población brasileña: una revisión sistemática

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Maximal inspiratory and expiratory pressures (MIP and MEP) assess the strength index of the respiratory muscles. These measures are relevant to assess respiratory muscle strength and for clinical monitoring. This study evaluates papers that suggest predictive equations of MIP and MEP for the Brazilian population. We included studies that established prediction equations for MIP and MEP for the healthy Brazilian population, aged from 4 to 90 years old, both men and women and that had the maximum respiratory pressures measured in a sitting position. A search was carried out in March 2020 on MEDLINE, LILACS, Cochrane, SciELO, CINAHL, Web of Science, and SCOPUS databases, without date or language filters. The descriptors used were “muscle strength,” “equations,” “predictive respiratory muscles” and their respective synonyms. Out of the 3,920 studies found in databases, 963 were duplicates, 2,779 were excluded, 178 had their full texts analyzed, and only 9 met the inclusion criteria. The predictive equations of ventilatory muscle strength analyzed in this review used age, weight, and stature as variables. However, the studies showed methodological weaknesses, such as lack of cross-validation of the equation, exclusion of outliers, and lack of familiarization of MIP and MEP.

Keywords:
Predictive Equations; Ventilatory Muscles; Maximal Inspiratory Pressure; Maximal Expiratory Pressure

Study	Sample	Age	Body mass (kg)	Height (cm)	BMI (kg/m2)	Level of physical activity	Location
Rosa et al., 2017³¹31. Da Rosa GJ, Morcillo AM, de Assumpção MS, Schivinski CIS. Predictive equations for maximal respiratory pressures of children aged 7-10. Braz J Phys Ther. 2017;21(1):30-6. doi: 10.1016/j.bjpt.2016.04.002. https://doi.org/10.1016/j.bjpt.2016.04.0...	n=399	RAG	RAG	RAG	RAG	NR	Florianópolis
	201 F/198 M
	7-10 years
Borja et al., 2015³²32. Borja RO, Campos TF, Freitas DA, Macêdo TMFM, Mendonça WCM, Mendonça KMPP. Predicted normal values for maximal respiratory pressures in children. Conscientiae Saude. 2015;14(2):187-94. doi: 10.5585/conssaude.v14n2.5109. https://doi.org/10.5585/conssaude.v14n2....	n=144	M=9.0±1.2	RAG	RAG	RAG	NR	Rio Grande do Norte
	F 81/63 M	F=8.7±1.2
	7-11 years
Pessoa et al., 2014¹⁸18. Pessoa IMBS, Houri Neto M, Montemezzo D, Silva LAM, Andrade AD, Parreira VF. Predictive equations for respiratory muscle strength according to international and Brazilian guidelines. Braz J Phys Ther. 2014;18(5):410-8. doi: 10.1590/bjpt-rbf.2014.0044. https://doi.org/10.1590/bjpt-rbf.2014.00...	n=134	M=47±18	M=77±9	M=174±0.08	M=25±2	M=39% S	Belo Horizonte
	74 F/60M	F=43±16	F=61±8	F= 160±0.07	F=24±3	F=51% S
	20-89 years
De Freitas et al., 2014²⁰20. de Freitas Dantas Gomes EL, Peixoto-Souza FS, de Carvalho EFT, do Nascimento ESP, Malosa Sampaio LM, ELoi JS, et al. Maximum respiratory pressures: values found and predicted in children. J Lung Pulm Respir Res. 2014;1(3):00014. doi: 10.15406/jlprr.2014.01.00014. https://doi.org/10.15406/jlprr.2014.01.0...	n=148	RAG	RAG	RAG	RAG	NR	São Paulo
	5-10 years
Mendes et al., 2013²¹21. Mendes REF, Campos TF, Macedo TMF, Borja RO, Parreira VF, Mendonca KMPP. Prediction equations for maximal respiratory pressures of Brazilian adolescents. Braz J Phys Ther. 2013;17(3):218-26. doi: 10.1590/S1413-35552012005000086. https://doi.org/10.1590/S1413-3555201200...	n=182	RAG	RAG	RAG	RAG	NR	Natal
	84 F/98 M
	12-18 years
Heinzmann-Filho et al., 2012²²22. Heinzmann-Filho JP, Vidal PCV, Jones MH, Donadio MVF. Normal values for respiratory muscle strength in healthy preschoolers and school children. Respir Med. 2012;106(12):1639-46. doi: 10.1016/j.rmed.2012.08.015. https://doi.org/10.1016/j.rmed.2012.08.0...	n=171	RAG	M=31.37±11.66	F=129.78±13.63	M=18.09±3.41	NR	Porto Alegre
	88 F/83 M		F=33.75±13.32	M=132.15±16.69	F=18.52±3.39
	4-12 years
Simões et al., 2010¹⁹19. Simões RP, Deus APL, Auad MA, Dionísio J, Mazzonetto M, Borghi-Silva A. Maximal respiratory pressure in healthy 20 to 89 year-old sedentary individuals of central São Paulo State. Braz J Phys Ther. 2010;14(1):60-7. doi: 10.1590/S1413-35552010000100010. https://doi.org/10.1590/S1413-3555201000...	n=140	RAG	RAG	RAG	RAG	IS	São Paulo
	70 F/70 M
	20-89 years
Costa et al., 2010¹⁷17. Costa D, Gonçalves HA, Lima LP, Ike D, Cancelliero KM, Montebelo MIL. Novos valores de referência para pressões respiratórias máximas na população brasileira. J Bras Pneumol. 2010;36(3):306-12. doi: 10.1590/S1806-37132010000300007. https://doi.org/10.1590/S1806-3713201000...	n=120	RAG	RAG	RAG	RAG	NR	São Paulo
	60 F/60 M
	20-80 years
*Neder et al., 1999⁸8. Neder JA, Andreoni S, Lerario MC, Nery LE. Reference values for lung function tests: II. Maximal respiratory pressures and voluntary ventilation. Braz J Med Biol Res. 1999;32(6):719-27. doi: 10.1590/S0100-879X1999000600007. https://doi.org/10.1590/S0100-879X199900...	n=100	RAG	M=73.8±10.7	M=168.4±6.2	M=25.3±3.9	88 S and 12 A	São Paulo
	50 F/50 M		F=62.5±10.8	F=157.1±7.1	F=24.7±4.0
	20-80 years

Study	Independent variables	Familiarization	Equipment	Calibration of the equipment	Cross validation	Exclusion of outliers	Statistical analysis
Rosa et al., 2017³¹31. Da Rosa GJ, Morcillo AM, de Assumpção MS, Schivinski CIS. Predictive equations for maximal respiratory pressures of children aged 7-10. Braz J Phys Ther. 2017;21(1):30-6. doi: 10.1016/j.bjpt.2016.04.002. https://doi.org/10.1016/j.bjpt.2016.04.0...	age, weight, and height	NR	Digital Manovacuometer	NR	NR	R	MLR
Borja et al., 2015³²32. Borja RO, Campos TF, Freitas DA, Macêdo TMFM, Mendonça WCM, Mendonça KMPP. Predicted normal values for maximal respiratory pressures in children. Conscientiae Saude. 2015;14(2):187-94. doi: 10.5585/conssaude.v14n2.5109. https://doi.org/10.5585/conssaude.v14n2....	Sex, age, and weight	NR	Digital Manovacuometer	NR	NR	NR	MLR
Pessoa et al.,¹⁸18. Pessoa IMBS, Houri Neto M, Montemezzo D, Silva LAM, Andrade AD, Parreira VF. Predictive equations for respiratory muscle strength according to international and Brazilian guidelines. Braz J Phys Ther. 2014;18(5):410-8. doi: 10.1590/bjpt-rbf.2014.0044. https://doi.org/10.1590/bjpt-rbf.2014.00... 2014	Sex, age, weight, and AC	NR	Digital Manovacuometer	Calibrated	NR	NR	MLR
De Freitas et al.,2014²⁰20. de Freitas Dantas Gomes EL, Peixoto-Souza FS, de Carvalho EFT, do Nascimento ESP, Malosa Sampaio LM, ELoi JS, et al. Maximum respiratory pressures: values found and predicted in children. J Lung Pulm Respir Res. 2014;1(3):00014. doi: 10.15406/jlprr.2014.01.00014. https://doi.org/10.15406/jlprr.2014.01.0...	Age, height, and body mass	NR	Analog Manovacuometer	Calibrated	NR	NR	MLR
Mendes et al., 2013²¹21. Mendes REF, Campos TF, Macedo TMF, Borja RO, Parreira VF, Mendonca KMPP. Prediction equations for maximal respiratory pressures of Brazilian adolescents. Braz J Phys Ther. 2013;17(3):218-26. doi: 10.1590/S1413-35552012005000086. https://doi.org/10.1590/S1413-3555201200...	Sex and body mass	NR	Digital Manovacuometer	NR	NR	NR	MLR
Heinzmann-Filho et al., 2012²²22. Heinzmann-Filho JP, Vidal PCV, Jones MH, Donadio MVF. Normal values for respiratory muscle strength in healthy preschoolers and school children. Respir Med. 2012;106(12):1639-46. doi: 10.1016/j.rmed.2012.08.015. https://doi.org/10.1016/j.rmed.2012.08.0...	Age, height, and body mass	NR	Digital Manovacuometer	Calibrated	NR	NR	MLR
Simões et al., 2010¹⁹19. Simões RP, Deus APL, Auad MA, Dionísio J, Mazzonetto M, Borghi-Silva A. Maximal respiratory pressure in healthy 20 to 89 year-old sedentary individuals of central São Paulo State. Braz J Phys Ther. 2010;14(1):60-7. doi: 10.1590/S1413-35552010000100010. https://doi.org/10.1590/S1413-3555201000...	Age, height, and body mass	NR	Analog Manovacuometer	NR	NR	NR	MLR
Costa et al., 2010¹⁷17. Costa D, Gonçalves HA, Lima LP, Ike D, Cancelliero KM, Montebelo MIL. Novos valores de referência para pressões respiratórias máximas na população brasileira. J Bras Pneumol. 2010;36(3):306-12. doi: 10.1590/S1806-37132010000300007. https://doi.org/10.1590/S1806-3713201000...	Age, height, and body mass	NR	Analog Manovacuometer	Calibrated	NR	NR	SLR
*Neder et al., 1999⁸8. Neder JA, Andreoni S, Lerario MC, Nery LE. Reference values for lung function tests: II. Maximal respiratory pressures and voluntary ventilation. Braz J Med Biol Res. 1999;32(6):719-27. doi: 10.1590/S0100-879X1999000600007. https://doi.org/10.1590/S0100-879X199900...	Age, height and body mass, Level of physical activity, VO₂máx, Leg strength	NR	Analog Manovacuometer	Calibrated	NR	NR	MLR

Study	Predictive equations	R²	SEE (cmH₂O)	p-value
Rosa et al, 2017³¹31. Da Rosa GJ, Morcillo AM, de Assumpção MS, Schivinski CIS. Predictive equations for maximal respiratory pressures of children aged 7-10. Braz J Phys Ther. 2017;21(1):30-6. doi: 10.1016/j.bjpt.2016.04.002. https://doi.org/10.1016/j.bjpt.2016.04.0...	M=Log(MIP)=1.577+0.006×weight(kg)	14.1*	0.033**	NR
	F=Log(MIP)=1.548+0.006×weight(kg)	15.0*	0.028**
Borja et al, 2015³²32. Borja RO, Campos TF, Freitas DA, Macêdo TMFM, Mendonça WCM, Mendonça KMPP. Predicted normal values for maximal respiratory pressures in children. Conscientiae Saude. 2015;14(2):187-94. doi: 10.5585/conssaude.v14n2.5109. https://doi.org/10.5585/conssaude.v14n2....	MIP=62.1+15.4×Sex+7.3×Age	0.15	NR	0.001 (sex)
	F=0; M=1			0.028 (age)
Pessoa et al., 2014¹⁸18. Pessoa IMBS, Houri Neto M, Montemezzo D, Silva LAM, Andrade AD, Parreira VF. Predictive equations for respiratory muscle strength according to international and Brazilian guidelines. Braz J Phys Ther. 2014;18(5):410-8. doi: 10.1590/bjpt-rbf.2014.0044. https://doi.org/10.1590/bjpt-rbf.2014.00...	63.27-0.55(age)+17.96(Sex)+0.58(body mass); M=1; F=0	R2=0.34	26	p<0.05
De Freitas et al., 2014²⁰20. de Freitas Dantas Gomes EL, Peixoto-Souza FS, de Carvalho EFT, do Nascimento ESP, Malosa Sampaio LM, ELoi JS, et al. Maximum respiratory pressures: values found and predicted in children. J Lung Pulm Respir Res. 2014;1(3):00014. doi: 10.15406/jlprr.2014.01.00014. https://doi.org/10.15406/jlprr.2014.01.0...	M=−62.2+1.26(age)+0.50(body mass)+80.1(height)	R²adj=0.63	NR	NR
	F=7.31+3.2(age)+0.47(body mass)+9.7(height)	R²adj=0.48	NR
Mendes et al., 2013²¹21. Mendes REF, Campos TF, Macedo TMF, Borja RO, Parreira VF, Mendonca KMPP. Prediction equations for maximal respiratory pressures of Brazilian adolescents. Braz J Phys Ther. 2013;17(3):218-26. doi: 10.1590/S1413-35552012005000086. https://doi.org/10.1590/S1413-3555201200...	53.8+26.1(Sex)+0.4(body mass)		24	NR
	M=1; F=0	R²adj=0.27
Heinzmann-Filho et al., 2012²²22. Heinzmann-Filho JP, Vidal PCV, Jones MH, Donadio MVF. Normal values for respiratory muscle strength in healthy preschoolers and school children. Respir Med. 2012;106(12):1639-46. doi: 10.1016/j.rmed.2012.08.015. https://doi.org/10.1016/j.rmed.2012.08.0...	M=17.879−[0.674×height]−[0.604xbody mass]	R²=0.58	13	NR
	F=14.226−[0.551×height]−[0.638×body mass]	R²=0.59	15
Simões et al., 2010¹⁹19. Simões RP, Deus APL, Auad MA, Dionísio J, Mazzonetto M, Borghi-Silva A. Maximal respiratory pressure in healthy 20 to 89 year-old sedentary individuals of central São Paulo State. Braz J Phys Ther. 2010;14(1):60-7. doi: 10.1590/S1413-35552010000100010. https://doi.org/10.1590/S1413-3555201000...	M=−0.76(age)+125	R²=0.72	15	p<0.05
	F=−0.85(age)+80.7+(−0.3)(body mass)	R²=0.84	42
Costa et al., 2010¹⁷17. Costa D, Gonçalves HA, Lima LP, Ike D, Cancelliero KM, Montebelo MIL. Novos valores de referência para pressões respiratórias máximas na população brasileira. J Bras Pneumol. 2010;36(3):306-12. doi: 10.1590/S1806-37132010000300007. https://doi.org/10.1590/S1806-3713201000...	M=−1.14(age)+149.33	R²=0.52	20	NR
	F=−0.46(age)+74.25	R²=0.25	17
Neder et al., 1999⁸8. Neder JA, Andreoni S, Lerario MC, Nery LE. Reference values for lung function tests: II. Maximal respiratory pressures and voluntary ventilation. Braz J Med Biol Res. 1999;32(6):719-27. doi: 10.1590/S0100-879X1999000600007. https://doi.org/10.1590/S0100-879X199900...	M=−0.80(age)+155.3	R²=0.48	17	p<0.01
	F=−0.49(age)+110.4	R²=0.46	9

Study	Predictive equations	R²	SEE (cmH₂O)	p-value
Rosa et al, 2017³¹31. Da Rosa GJ, Morcillo AM, de Assumpção MS, Schivinski CIS. Predictive equations for maximal respiratory pressures of children aged 7-10. Braz J Phys Ther. 2017;21(1):30-6. doi: 10.1016/j.bjpt.2016.04.002. https://doi.org/10.1016/j.bjpt.2016.04.0...	M=Log(MEP)=1.282+0.409×height(cm)	13.9*	0.097**	NR
	F=Log(MEP)=1.6+0.013×age(y)+0.005×weight(kg)	21.6*	0.028**
Borja et al, 2015³²32. Borja RO, Campos TF, Freitas DA, Macêdo TMFM, Mendonça WCM, Mendonça KMPP. Predicted normal values for maximal respiratory pressures in children. Conscientiae Saude. 2015;14(2):187-94. doi: 10.5585/conssaude.v14n2.5109. https://doi.org/10.5585/conssaude.v14n2....	MEP=73.7+16.5×Sex+9.5×Age	0.18	NR	0.0001 (sex)
	F=0 ; M=1			0.005 (age)
Pessoa et al., 2014¹⁸18. Pessoa IMBS, Houri Neto M, Montemezzo D, Silva LAM, Andrade AD, Parreira VF. Predictive equations for respiratory muscle strength according to international and Brazilian guidelines. Braz J Phys Ther. 2014;18(5):410-8. doi: 10.1590/bjpt-rbf.2014.0044. https://doi.org/10.1590/bjpt-rbf.2014.00...	−61.41+2.29(age)-0.03(age2)+33.72(Sex)+1.40(abdominal circumference)	R²=0.49	33	p<0.05
	M=1; F=0
De Freitas et al., 2014²⁰20. de Freitas Dantas Gomes EL, Peixoto-Souza FS, de Carvalho EFT, do Nascimento ESP, Malosa Sampaio LM, ELoi JS, et al. Maximum respiratory pressures: values found and predicted in children. J Lung Pulm Respir Res. 2014;1(3):00014. doi: 10.15406/jlprr.2014.01.00014. https://doi.org/10.15406/jlprr.2014.01.0...	M=49.6+7.23(age)+0.47(body mass)+−37.3(height)	R²adj=0.25	NR	NR
	F=10.8+4.05(age)+0.08(body mass)+30.4(height)	R²adj=0.55
Mendes et al., 2013²¹21. Mendes REF, Campos TF, Macedo TMF, Borja RO, Parreira VF, Mendonca KMPP. Prediction equations for maximal respiratory pressures of Brazilian adolescents. Braz J Phys Ther. 2013;17(3):218-26. doi: 10.1590/S1413-35552012005000086. https://doi.org/10.1590/S1413-3555201200...	86.85+34.22(Sex)	R²adj=0.27	27	NR
	M=1; F=0
Heinzmann-Filho et al., 2012²²22. Heinzmann-Filho JP, Vidal PCV, Jones MH, Donadio MVF. Normal values for respiratory muscle strength in healthy preschoolers and school children. Respir Med. 2012;106(12):1639-46. doi: 10.1016/j.rmed.2012.08.015. https://doi.org/10.1016/j.rmed.2012.08.0...	M=47.417+[0.898 body mass]+[3.166×age]	R²=0.46	19	NR
	F=30.045+[0.749×body mass]+[4.213×age]	R²=0.51	19
Simões et al., 2010¹⁹19. Simões RP, Deus APL, Auad MA, Dionísio J, Mazzonetto M, Borghi-Silva A. Maximal respiratory pressure in healthy 20 to 89 year-old sedentary individuals of central São Paulo State. Braz J Phys Ther. 2010;14(1):60-7. doi: 10.1590/S1413-35552010000100010. https://doi.org/10.1590/S1413-3555201000...	M=0.83(age)+87.69	R²=0.84	15	p<0.05
	F=−0.89(age)+125.1+(−0.18) body mass	R²=0.77	12
Costa et al., 2010¹⁷17. Costa D, Gonçalves HA, Lima LP, Ike D, Cancelliero KM, Montebelo MIL. Novos valores de referência para pressões respiratórias máximas na população brasileira. J Bras Pneumol. 2010;36(3):306-12. doi: 10.1590/S1806-37132010000300007. https://doi.org/10.1590/S1806-3713201000...	M=−1.26(age)+183.31	R²=0.49	24	NR
	F=−0.68(age)+119.35	R²=0.35	18
Neder et al., 1999⁸8. Neder JA, Andreoni S, Lerario MC, Nery LE. Reference values for lung function tests: II. Maximal respiratory pressures and voluntary ventilation. Braz J Med Biol Res. 1999;32(6):719-27. doi: 10.1590/S0100-879X1999000600007. https://doi.org/10.1590/S0100-879X199900... ^),(³³33. Barreto LM, Duarte MA, de Oliveira Moura SCD, Alexandre BL, Augusto LS, Fontes MJF. Comparação dos valores medidos e previstos de pressões respiratórias máximas em escolares saudáveis. Fisioter Pesq. 2013;20(3):235-43. http://dx.doi.org/10.1590/S1809-29502013000300007. https://doi.org/http://dx.doi.org/10.159... *	M=−0.81(age)+165.3	R²=0.48	15	p<0.05
	F=−0.61(age)+115.6	R²=0.48	11

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[1] Corresponding address: Glória de Paula Silva - Rua São Francisco Xavier, 524 - Rio de Janeiro (RJ), Brazil - ZIP Code: 20550-900 - E-mail: gloriaps_ibnj@hotmail.com