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obstru&#231;&#227;o do fluxo a&#233;reo&#44; o que leva a uma hipertrofia adaptativa<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#44;7</span></a>&#46; Esses m&#250;sculos&#44; quando colocados sob tens&#227;o&#44; encurtam-se e perdem a flexibilidade<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a>&#46; No entanto&#44; uma vez que existe uma interdepend&#234;ncia biomec&#226;nica no sistema locomotor humano&#44; qualquer anormalidade da caixa tor&#225;cica influencia a mec&#226;nica de todo o corpo<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a>&#46; Neste sentido&#44; a avalia&#231;&#227;o postural &#233; de fundamental import&#226;ncia para o diagn&#243;stico&#44; planejamento e monitoramento dos resultados obtidos com a fisioterapia&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">A obesidade &#233; uma condi&#231;&#227;o comum em adultos portadores de asma e est&#225; geralmente associada com a piora dos sintomas e o uso de corticosteroides orais<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12&#44;13</span></a>&#46; Pacientes obesos portadores de asma apresentam fun&#231;&#227;o pulmonar reduzida e pior qualidade de vida quando comparados a indiv&#237;duos eutr&#243;ficos<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a>&#46; Estudos de base populacional sugerem que&#160;valores&#160;elevados de&#160;gordura corporal e valores baixos de massa magra &#40;MM&#41; s&#227;o preditores de mortalidade&#44; independente da doen&#231;a de base<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a>&#46; Al&#233;m disso&#44; os percentuais de massa gorda &#40;MG&#41; e MM apresentam correla&#231;&#227;o com a fun&#231;&#227;o pulmonar&#46; Tem sido demonstrado que a perda de peso e a diminui&#231;&#227;o do &#237;ndice de massa corporal &#40;IMC&#41; est&#227;o associados com a melhora da fun&#231;&#227;o pulmonar<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">A asma pode causar repercuss&#245;es sist&#233;micas devido &#224; sua gravidade e aos efeitos do tratamento<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12&#44;13</span></a>&#46; Nossa hip&#243;tese &#233; que&#44; em adultos com asma&#44; as altera&#231;&#245;es na mec&#226;nica respirat&#243;ria e a obesidade interferem com a postura do corpo&#46; Acreditamos que o conhecimento do impacto das anormalidades da fun&#231;&#227;o pulmonar e da obesidade na postura do corpo podem ajudar a evitar danos posturais desses pacientes&#46; Assim&#44; nosso objetivo prim&#225;rio foi avaliar a correla&#231;&#227;o entre fun&#231;&#227;o pulmonar e postura&#46; Como objetivo secund&#225;rio investigamos a correla&#231;&#227;o entre composi&#231;&#227;o corporal e postura em pacientes adultos portadores de asma&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">M&#233;todos</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Pacientes</span><p id="par0030" class="elsevierStylePara elsevierViewall">Este &#233; um estudo transversal com pacientes recrutados no Posto de Atendimento M&#233;dico Newton Bethlem&#44; na cidade do Rio de Janeiro&#44; Brasil&#46; Foram inclu&#237;dos indiv&#237;duos com diagn&#243;stico de asma e idade entre 18 e 50 anos&#46; Foram exclu&#237;dos pacientes com hist&#243;ria de tabagismo&#44; pacientes que faziam uso de medicamentos psicotr&#243;picos e aqueles que tinham uma hist&#243;ria de comorbidades respirat&#243;rias&#46; O estudo foi aprovado &#40;n&#46;<span class="elsevierStyleSup">o</span> 012&#47;2011&#41; pelo Comit&#234; de &#255;tica da institui&#231;&#227;o onde foi realizada a pesquisa e todos os pacientes assinaram um termo de consentimento informado&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Medidas</span><p id="par0035" class="elsevierStylePara elsevierViewall">A an&#225;lise postural foi realizada atrav&#233;s de fotogrametria utilizando-se o <span class="elsevierStyleItalic">software</span> de avalia&#231;&#227;o postural &#40;SAPO&#41; &#40;Incubadora FAPESP&#44; SP&#44; Brasil&#41;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a>&#46; As coordenadas dos pontos anat&#243;micos &#40;trago direito e esquerdo&#44; acr&#243;mio direito e esquerdo&#44; troc&#226;nter maior do f&#234;mur direito e esquerdo e processos espinhosos da s&#233;tima v&#233;rtebra cervical e terceira v&#233;rtebra tor&#225;cica&#41; foram demarcadas com marcadores passivos &#40;bolas de isopor com fita adesiva dupla face&#41;&#46; As fotografias foram realizadas com todos os indiv&#237;duos em vista anterior&#44; posterior&#44; lateral direita e lateral esquerda&#46; Em seguida&#44; as fotografias foram transferidas para um microcomputador compat&#237;vel e analisadas&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Atrav&#233;s de um sistema computadorizado&#44; modelo <span class="elsevierStyleItalic">Collins Plus Pulmonary Function Testing Systems</span> &#40;Warren E&#46; Collins&#44; Inc&#46;&#44; Braintree&#44; MA&#44; USA&#41;&#44; foram realizados os seguintes exames&#58; espirometria&#44; pletismografia de corpo inteiro&#44; medi&#231;&#227;o da capacidade de difus&#227;o do CO &#40;DLco&#41; e avalia&#231;&#227;o da for&#231;a muscular respirat&#243;ria&#46; Todos estes testes seguiram a padroniza&#231;&#227;o e interpreta&#231;&#227;o da American Thoracic Society &#40;ATS&#41;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a>&#46; Foram adotadas as equa&#231;&#245;es de Pereira<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> &#40;espirometria&#41; e Neder &#40;volumes pulmonares&#44; DLCO e for&#231;a muscular&#41; na interpreta&#231;&#227;o dos par&#226;metros funcionais<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">19&#12287;22</span></a>&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">A an&#225;lise de composi&#231;&#227;o corporal foi realizada utilizando-se um aparelho de bioimped&#226;ncia el&#233;trica &#40;BIA 310e&#44; Biodynamics&#44; Seattle&#44; WA&#44; USA&#41;&#46; Os indiv&#237;duos eram orientados a descansar durante 5 min antes do exame e permaneciam descal&#231;os&#44; sem nenhum objeto met&#225;lico pr&#243;ximo a eles&#44; com os p&#233;s afastados entre 15 e 30<span class="elsevierStyleHsp" style=""></span>cm<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a>&#46; Dois eletrodos eram colocados na face dorsal da m&#227;o direita e outros 2 na face dorsal do p&#233; direito&#46; Resist&#234;ncia e reat&#226;ncia foram calculadas e usadas para estimar a MM&#46; A equa&#231;&#227;o selecionada foi previamente validada para indiv&#237;duos brasileiros&#58; MM<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>-4&#46;104<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>&#40;0&#44;518 &#255; altura<span class="elsevierStyleSup">&#40;2&#41;</span>&#47;resist&#234;ncia&#41;<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>&#40;0&#44;231<span class="elsevierStyleHsp" style=""></span>&#255;<span class="elsevierStyleHsp" style=""></span>peso&#41;<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>&#40;0&#44;130<span class="elsevierStyleHsp" style=""></span>&#255;<span class="elsevierStyleHsp" style=""></span>reat&#226;ncia&#41;<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>&#40;4&#46;229<span class="elsevierStyleHsp" style=""></span>&#255;<span class="elsevierStyleHsp" style=""></span>g&#234;nero&#58; homem<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44; mulher<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#41;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a>&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">An&#225;lise estat&#237;stica</span><p id="par0050" class="elsevierStylePara elsevierViewall">Os dados foram descritos atrav&#233;s da mediana e dos intervalos interquartis &#40;percentis 25 e 75&#37;&#41;&#44; ou da frequ&#234;ncia &#40;percentagem&#41;&#46; Como as vari&#225;veis foram consideradas de distribui&#231;&#227;o n&#227;o normal pelo teste de Shapiro-Wilk&#44; o estudo das correla&#231;&#245;es foi realizado atrav&#233;s do teste de Spearman&#46; As an&#225;lises foram feitas atrav&#233;s do programa <span class="elsevierStyleItalic">SigmaStat for Windows</span>&#44; vers&#227;o 3&#44;5 &#40;Systat Softaware&#44; Inc&#46;&#44; Chicago&#44; IL&#44; USA&#41;&#46; Considerou-se signific&#226;ncia estat&#237;stica <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#46;</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Resultados</span><p id="par0055" class="elsevierStylePara elsevierViewall">Dos 46 pacientes com asma inicialmente recrutados&#44; 12 foram exclu&#237;dos pelos seguintes motivos&#58; recusa em participar do estudo &#40;3&#41;&#44; doen&#231;a restritiva associada &#40;4&#41;&#44; incapacidade para realizar os testes de fun&#231;&#227;o pulmonar &#40;4&#41; e morte &#40;1&#41;&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Os dados antropom&#233;tricos&#44; composi&#231;&#227;o corporal e fun&#231;&#227;o pulmonar s&#227;o apresentados na <a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#44; enquanto os dados de avalia&#231;&#227;o postural s&#227;o mostrados na <a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a>&#46; Embora tenha havido uma ligeira discrep&#226;ncia entre os valores m&#233;dios dos lados direito e esquerdo do corpo nas vari&#225;veis fornecidas pelo SAPO&#44; estes valores n&#227;o apresentaram diferen&#231;as estatisticamente significantes &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span> &#62;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">A <a class="elsevierStyleCrossRef" href="#tbl0015">tabela 3</a> descreve as correla&#231;&#245;es entre composi&#231;&#227;o corporal e avalia&#231;&#227;o postural&#44; enquanto a <a class="elsevierStyleCrossRef" href="#tbl0020">tabela 4</a> mostra as correla&#231;&#245;es entre fun&#231;&#227;o pulmonar e avalia&#231;&#227;o postural&#59; nessas tabelas s&#227;o apresentados apenas os dados com diferen&#231;as estatisticamente significantes&#46; Houve correla&#231;&#227;o significante dos desvios posturais com os indicadores de obstru&#231;&#227;o br&#244;nquica&#44; incluindo a diminui&#231;&#227;o da rela&#231;&#227;o entre o volume expirat&#243;rio m&#225;ximo no primeiro segundo e a capacidade vital for&#231;ada &#40;VEMS&#47;CVF&#41;&#44; a redu&#231;&#227;o do d&#233;bito expirat&#243;rio m&#225;ximo instant&#226;neo &#40;DEMI&#41;&#44; o aumento de capacidade pulmonar total &#40;CPT&#41; e do volume residual &#40;VR&#41; e a eleva&#231;&#227;o da resist&#234;ncia das vias a&#233;reas &#40;Rva&#41;&#46; Os par&#226;metros de avalia&#231;&#227;o postural tamb&#233;m apresentaram correla&#231;&#227;o significante com as medidas de for&#231;a muscular respirat&#243;ria&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Discuss&#227;o</span><p id="par0070" class="elsevierStylePara elsevierViewall">Os principais achados do estudo foram que&#44; em pacientes adultos com asma h&#225; uma forte associa&#231;&#227;o entre os desvios da postura do corpo e as vari&#225;veis de obstru&#231;&#227;o das vias a&#233;reas&#44; incluindo o aprisionamento de ar e a insufla&#231;&#227;o&#46; Al&#233;m disso&#44; tanto a for&#231;a muscular respirat&#243;ria quanto a composi&#231;&#227;o corporal contribuem para as altera&#231;&#245;es posturais&#46; Para o melhor do nosso conhecimento&#44; este &#233; o primeiro estudo a avaliar a rela&#231;&#227;o entre fun&#231;&#227;o pulmonar&#44; postura e composi&#231;&#227;o corporal em pacientes adultos com asma&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">A avalia&#231;&#227;o postural em ortostatismo tem sido cada vez mais utilizada na pr&#225;tica cl&#237;nica&#44; visto que a observa&#231;&#227;o do alinhamento do corpo pode ser usada para planejar e monitorar os efeitos do tratamento fisioterap&#234;utico&#46; A fotogrametria atrav&#233;s do SAPO tem sido utilizada para avaliar as correla&#231;&#245;es entre postura&#44; fun&#231;&#227;o pulmonar e composi&#231;&#227;o corporal<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">24&#12287;26</span></a>&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Comparado aos valores normais<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a>&#44; observamos uma maior anterioriza&#231;&#227;o da cabe&#231;a e um aumento da lordose lombar em indiv&#237;duos asm&#225;ticos&#44; assim como a flex&#227;o dos quadris e dos joelhos bilateralmente&#46; Embora uma ligeira discrep&#226;ncia tenha sido encontrada entre os valores dos lados direito e esquerdo do corpo nas vari&#225;veis fornecidas pelo SAPO&#44; estes valores n&#227;o apresentaram diferen&#231;as estatisticamente significantes &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46; Esta relativa simetria pode ser justificada pelo fato da asma afetar os pulm&#245;es de maneira difusa e tamb&#233;m pelo fato dos pacientes com comorbidades que causam desvios posturais terem sido exclu&#237;dos do atual estudo&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">No que tange &#224; composi&#231;&#227;o corporal&#44; algumas altera&#231;&#245;es posturais como o alinhamento horizontal da cabe&#231;a &#40;AHC&#41; e o &#226;ngulo frontal dos&#160;membros inferiores &#40;AFMI&#41; apresentaram correla&#231;&#227;o positiva com o &#237;ndice de massa corporal &#40;IMC&#41; e negativa com a MG&#44; enquanto o &#226;ngulo do joelho mostrou correla&#231;&#227;o positiva e estatisticamente significante com a MM&#46; Provavelmente a associa&#231;&#227;o entre a composi&#231;&#227;o corporal e as vari&#225;veis que avaliam os desvios posturais na metade inferior do corpo foi por causa da maior distribui&#231;&#227;o de gordura corporal no quadril&#46; Este padr&#227;o de distribui&#231;&#227;o da gordura corporal &#40;tamb&#233;m conhecido como &#171;padr&#227;o ginoide&#187;&#41; &#233; um achado comum entre as mulheres&#44; as quais representam a maioria da nossa amostra&#44; e est&#225; em acordo com os estudos que mostram a maior preval&#234;ncia da asma em mulheres<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">27&#44;28</span></a>&#46; Curiosamente&#44; Beckett et al&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a> mostraram que a asma est&#225; associada ao ganho de peso em mulheres&#44; mas n&#227;o em homens&#44; independentemente da atividade f&#237;sica&#46; Assim&#44; pensamos que este fato pode ter influenciado os resultados do atual estudo&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Robles-Ribeiro et al&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a> observaram que pacientes adultos com asma leve a grave apresentam diversas altera&#231;&#245;es posturais&#46;&#160;Estes autores tamb&#233;m notaram que&#44; quanto maior a protra&#231;&#227;o dos ombros&#44; menor o DEMI&#46; Entretanto&#44; a presente investiga&#231;&#227;o n&#227;o identificou uma correla&#231;&#227;o dessas altera&#231;&#245;es com a fun&#231;&#227;o pulmonar&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Quando avaliamos a correla&#231;&#227;o entre as vari&#225;veis da postura e as press&#245;es musculares m&#225;ximas&#44; observamos um predom&#237;nio nas altera&#231;&#245;es de tronco e p&#233;lvis &#40;alinhamento vertical do tronco - direito&#47;alinhamento vertical do tronco - esquerdo&#59; alinhamento horizontal da p&#233;lvis - direito&#47;alinhamento horizontal da p&#233;lvis - esquerdo&#59; &#226;ngulo do quadril direto&#47;&#226;ngulo do quadril esquerdo&#41; que correlacionaram de forma negativa com a press&#227;o inspirat&#243;ria m&#225;xima &#40;PI<span class="elsevierStyleInf">max</span>&#41; e com a press&#227;o expirat&#243;ria m&#225;xima &#40;PE<span class="elsevierStyleInf">max</span>&#41;&#46; Sabe-se que a fraqueza abdominal acarreta um aumento da lordose lombar em crian&#231;as&#44; principalmente por modifica&#231;&#227;o da musculatura obl&#237;qua e transversa do abd&#243;men<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a>&#46; Este grupo de m&#250;sculos tem um papel importante no processo de estabiliza&#231;&#227;o vertebral e na expira&#231;&#227;o for&#231;ada&#46; Dessa forma&#44; ele interfere nas medidas da PE<span class="elsevierStyleInf">max</span>&#46; No presente estudo tamb&#233;m observamos este fato em adultos&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Boulay et al&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a> observaram que a atitude postural do t&#243;rax insuflado acarreta uma s&#233;rie de compensa&#231;&#245;es na coluna tor&#225;cica&#44; cinturas escapular e p&#233;lvica&#44; visto que o diafragma encontra-se retificado e encurtado&#46; Como o diafragma tem liga&#231;&#245;es diretas com a f&#225;scia endotor&#225;cica&#44; a insufla&#231;&#227;o tor&#225;cica poderia resultar num aumento da cifose tor&#225;cica&#46; N&#227;o podemos afirmar que houve aumento da cifose tor&#225;cica em nosso estudo&#44; visto que o <span class="elsevierStyleItalic">software</span> de avalia&#231;&#227;o postural utilizado no presente estudo n&#227;o avalia esta vari&#225;vel&#46; No entanto&#44; podemos afirmar que as liga&#231;&#245;es diafragm&#225;ticas com outros m&#250;sculos do tronco&#44; como o iliopsoas&#44; tranverso do abd&#243;men e quadrado lombar podem acarretar antevers&#227;o p&#233;lvica e aumento da lordose lombar&#44; as quais foram observadas em nossos pacientes com asma e que tamb&#233;m correlacionaram com os volumes pulmonares<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a>&#46; Ao avaliar os volumes pulmonares est&#225;ticos e a Rva em pacientes com asma&#44; o fen&#243;meno mais marcante &#233; o aprisionamento de ar&#44; que &#233; a consequ&#234;ncia de um esvaziamento alveolar retardado&#46; A CPT pode tamb&#233;m estar aumentada devido &#224; perda do recolhimento el&#225;stico&#46; Outro mecanismo respons&#225;vel pelo aumento da CPT &#233; o encurtamento do tempo expirat&#243;rio em pacientes com asma&#44; de modo que a inspira&#231;&#227;o come&#231;a antes de terminada completamente a elimina&#231;&#227;o de ar nos pulm&#245;es&#46; Esses achados podem explicar as correla&#231;&#245;es significantes da CPT e da Rva com as modifica&#231;&#245;es do alinhamento vertical do tronco observadas em nosso estudo&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Diferentemente de Boulay et al&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a>&#44; n&#227;o encontramos correla&#231;&#227;o entre o desalinhamento p&#233;lvico e os volumes pulmonares&#46; Por&#233;m&#44; observamos correla&#231;&#227;o negativa do desalinhamento p&#233;lvico com a for&#231;a muscular e o <span class="elsevierStyleItalic">peak flow</span>&#44; onde os valores foram maiores no lado direito do corpo para todas as vari&#225;veis&#46; Nossa hip&#243;tese &#233; a presen&#231;a de uma diferen&#231;a na extens&#227;o da les&#227;o do par&#234;nquima pulmonar&#46; Uma maior destrui&#231;&#227;o alveolar&#44; em um dos pulm&#245;es&#44; resulta em maior aprisionamento de ar e&#44; consequentemente&#44; uma retifica&#231;&#227;o e encurtamento do m&#250;sculo do diafragma&#44; intercostais e abdominais do mesmo lado do corpo&#46; Essas altera&#231;&#245;es unilaterais podem causar um desequil&#237;brio na cadeia muscular e resultar em desnivelamento p&#233;lvico&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">O aumento da DLco tem sido descrito em pacientes com asma&#44; incluindo aqueles que t&#234;m patologia est&#225;vel<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">32&#44;33</span></a>&#46; Diversos mecanismos foram propostos como poss&#237;veis explica&#231;&#245;es para estas anormalidades&#44; incluindo a perfus&#227;o aumentada dos &#225;pices pulmonares devido a uma eleva&#231;&#227;o da press&#227;o arterial pulmonar ou a uma press&#227;o pleural mais negativa como consequ&#234;ncia do estreitamento br&#244;nquico<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">32</span></a>&#46; No estudo atual n&#227;o foi encontrada nenhuma correla&#231;&#227;o entre DLco&#44; composi&#231;&#227;o corporal ou altera&#231;&#245;es posturais&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">&#255; importante uma an&#225;lise cr&#237;tica dos resultados e suas limita&#231;&#245;es&#46; A for&#231;a muscular respirat&#243;ria e perif&#233;rica e a composi&#231;&#227;o corporal s&#227;o afetadas pelo uso de esteroides orais&#44; os quais s&#227;o frequentemente prescritos para pacientes com asma&#46; Portanto&#44; o uso deste medicamento pode ser um fator de confus&#227;o&#46; Devido &#224; aus&#234;ncia de um grupo controle&#44; n&#227;o se pode afirmar qual o grau de interfer&#234;ncia do corticosteroide na amostra avaliada&#46; Al&#233;m disso&#44; nosso trabalho &#233; um estudo transversal&#46; Ele apenas indica associa&#231;&#245;es e n&#227;o permite o estabelecimento de rela&#231;&#245;es entre causa e efeito&#46; No entanto&#44; devido ao fato de que h&#225; poucos estudos publicados sobre a postura do corpo neste grupo de pacientes&#44; acreditamos que os resultados trazem uma importante contribui&#231;&#227;o para o campo&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Em conclus&#227;o&#44; nosso estudo mostra que pacientes adultos com asma apresentam altera&#231;&#245;es espec&#237;ficas na postura&#44; como um aumento da cifose tor&#225;cica e da lordose lombar&#46; Estas altera&#231;&#245;es posturais correlacionam-se com a fun&#231;&#227;o pulmonar e com a composi&#231;&#227;o corporal&#46; A avalia&#231;&#227;o postural pode fornecer uma melhor abordagem para os programas de reabilita&#231;&#227;o pulmonar nestes pacientes&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Responsabilidades &#233;ticas</span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Prote&#231;&#227;o dos seres humanos e animais</span><p id="par0125" class="elsevierStylePara elsevierViewall">Os autores declaram que os procedimentos seguidos estavam de acordo com os regulamentos estabelecidos pelos respons&#225;veis da Comiss&#227;o de Investiga&#231;&#227;o Cl&#237;nica e &#255;tica e de acordo com os da Associa&#231;&#227;o M&#233;dica Mundial e da Declara&#231;&#227;o de Helsinki&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Confidencialidade dos dados</span><p id="par0130" class="elsevierStylePara elsevierViewall">Os autores declaram ter seguido os protocolos de seu centro de trabalho acerca da publica&#231;&#227;o dos dados de pacientes e que todos os pacientes inclu&#237;dos no estudo receberam informa&#231;&#245;es suficientes e deram o seu consentimento informado por escrito para participar nesse estudo&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Direito &#224; privacidade e consentimento escrito</span><p id="par0135" class="elsevierStylePara elsevierViewall">Os autores declaram ter recebido consentimento escrito dos pacientes e&#47;ou sujeitos mencionados no artigo&#46; O autor para correspond&#234;ncia deve estar na posse deste documento&#46;</p></span></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Autoria&#47;Colaboradores</span><p id="par0140" class="elsevierStylePara elsevierViewall">V&#237;vian Pinto Almeida&#44; Fernando Silva Guimar&#227;es&#44; Sara Lucia Silveira Menezes&#44; Thiago Thomaz Mafort e Agnaldo Jos&#233; Lopes contribuiram para a concep&#231;&#227;o e projeto&#44; revis&#227;o do artigo e aprova&#231;&#227;o final da vers&#227;o do manuscrito&#46; Vanessa Joaquim Ribeiro Mo&#231;o realizou a an&#225;lise e a interpreta&#231;&#227;o dos dados&#44; revis&#227;o do artigo e aprova&#231;&#227;o final da vers&#227;o do manuscrito&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Conflito de interesses</span><p id="par0145" class="elsevierStylePara elsevierViewall">Os autores declaram n&#227;o haver conflito de interesses&#46;</p></span></span>"
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    "fechaRecibido" => "2012-10-16"
    "fechaAceptado" => "2013-03-11"
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            1 => "Testes de fun&#231;&#227;o respirat&#243;ria"
            2 => "Mec&#226;nica respirat&#243;ria"
            3 => "M&#250;sculos respirat&#243;rios"
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            2 => "Respiratory mechanics"
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            6 => "Body composition"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objetivos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A asma pode resultar em altera&#231;&#245;es posturais causadas pelo aumento da atividade da musculatura acess&#243;ria&#44; respirat&#243;ria e insufla&#231;&#227;o pulmonar&#46; Nosso objetivo prim&#225;rio foi avaliar a correla&#231;&#227;o entre fun&#231;&#227;o pulmonar e postura em pacientes adultos com asma&#46; Como segundo objetivo buscou-se estudar a correla&#231;&#227;o entre composi&#231;&#227;o corporal e postura neste grupo de pacientes&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">M&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Foi realizado um estudo transversal onde 34 pacientes com asma se submeteram &#224; avalia&#231;&#227;o da an&#225;lise postural &#40;fotogrametria&#41;&#44; fun&#231;&#227;o pulmonar &#40;espirometria&#44; pletismografia de corpo inteiro&#44; medi&#231;&#227;o da capacidade de difus&#227;o do CO e for&#231;a muscular respirat&#243;ria&#41; e composi&#231;&#227;o corporal atrav&#233;s da bioimped&#226;ncia el&#233;trica&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A maioria dos pacientes era do sexo feminino &#40;70&#44;6&#37;&#41;&#44; com mediana da idade de 32&#44;5 anos &#40;varia&#231;&#227;o&#58; 23-42 anos&#41;&#46; O alinhamento horizontal da cabe&#231;a &#40;vista anterior&#41; correlacionou de forma significante com as seguintes vari&#225;veis&#58; rela&#231;&#227;o entre o volume expirat&#243;rio m&#225;ximo no primeiro segundo e a capacidade vital for&#231;ada &#40;VEMS&#47;CVF&#41; &#40;&#1023; &#61; &#12287;0&#44;37&#59; P &#61; 0&#44;03&#41;&#59; capacidade pulmonar total &#40;CPT&#41; &#40;&#1023; &#61; 0&#44;42&#59; P &#61; 0&#44;01&#41;&#59; e volume residual &#40;VR&#41; &#40;&#1023; &#61; 0&#44;45&#59; P &#60; 0&#44;001&#41;&#46; Os indicadores de obstru&#231;&#227;o br&#244;nquica e for&#231;a muscular respirat&#243;ria correlacionaram-se tamb&#233;m com as medidas de avalia&#231;&#227;o postural obtidas em vista lateral direita e esquerda&#46; Tanto o &#237;ndice de massa corporal quanto o percentual de massa gorda correlacionaram-se com alinhamento horizontal da cabe&#231;a&#44; alinhamento horizontal da p&#233;lvis e &#226;ngulo frontal do&#160;membro inferior&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclus&#245;es</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Pacientes asm&#225;ticos adultos apresentam altera&#231;&#245;es posturais espec&#237;ficas que correlacionam com a fun&#231;&#227;o pulmonar e com a composi&#231;&#227;o corporal&#46; A avalia&#231;&#227;o das medidas posturais pode fornecer uma melhor abordagem para a reabilita&#231;&#227;o pulmonar nestes pacientes&#46;</p></span>"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Aim</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Asthma may result in postural disorders due to increased activity of accessory respiratory muscles and hyperinflation&#46; Our primary objective was to assess the correlation between pulmonary function and posture in adult patients with asthma&#46; Secondarily&#44; we aimed to study the correlation between body composition and body posture in this group of patients&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Method</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">This was a cross-sectional study including 34 patients with asthma who were subjected to postural assessment &#40;photogrammetry&#41;&#44; pulmonary function testing &#40;spirometry&#44; whole-body plethysmography&#44; diffusing capacity for carbon monoxide&#44; and respiratory muscle strength&#41;&#44; and body composition estimation by means of bioelectrical impedance&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Most patients were female &#40;70&#46;6&#37;&#41; with a median age of 32&#46;5 years &#40;range&#58; 23-42 years old&#41;&#46; We found a significant correlation between horizontal alignment of head &#40;anterior view&#41; and the ratio of forced expiratory volume in 1 second to forced vital capacity &#40;FEV<span class="elsevierStyleInf">1</span>&#47;FVC&#59; &#1023;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#12287;0&#44;37&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;03&#41;&#44; total lung capacity &#40;TLC&#59; &#1023;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;42&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;01&#41;&#44; and residual volume &#40;RV&#59; &#1023;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;45&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#46; Bronchial obstruction and respiratory muscle strength variables also correlated with postural assessment measures on the right and left lateral views&#46; Both body mass index and the percentage of fat mass correlated with horizontal alignment of head&#44; horizontal alignment of the pelvis&#44; and the frontal angle of the lower limbs&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusion</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Adult patients with asthma exhibit specific postural disorders that correlate with pulmonary function and body composition&#46; The assessment of postural variables may provide a better pulmonary rehabilitation approach for these patients&#46;</p></span>"
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          "leyenda" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Os resultados s&#227;o expressos como mediana &#40;intervalos interquartis&#41; ou n&#250;mero &#40;&#37;&#41;&#46;</p><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">CPT&#58; capacidade pulmonar total&#59; CVF&#58; capacidade vital for&#231;ada&#59; DEMI&#58; d&#233;bito expirat&#243;rio m&#225;ximo instant&#226;neo&#59; DLco&#58; capacidade de difus&#227;o do CO&#59; IMC&#58; &#237;ndice de massa corporal&#59; MG&#58; massa gorda&#59; MM&#58; massa magra&#59; PE<span class="elsevierStyleInf">max</span>&#58; press&#227;o expirat&#243;ria m&#225;xima&#59; PI<span class="elsevierStyleInf">max</span>&#58; press&#227;o inspirat&#243;ria m&#225;xima&#59; Rva&#58; resist&#234;ncia das vias a&#233;reas&#59; VEMS&#58; volume expirat&#243;rio m&#225;ximo no primeiro segundo&#59; VR&#58; volume residual&#46;</p>"
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">45&#44;4 &#40;39&#12287;51&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">94 &#40;79&#12287;104&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">53&#44;3 &#40;34&#44;1&#12287;66&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">PE<span class="elsevierStyleInf">max</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">54&#44;2 &#40;43&#44;7&#12287;76&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">CPT &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">120 &#40;103&#12287;125&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">VR &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">138 &#40;113&#12287;216&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">VR&#47;CPT &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">131 &#40;105&#12287;165&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">R<span class="elsevierStyleInf">va</span> &#40;cm H<span class="elsevierStyleInf">2</span>O&#47;L&#47;s&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;58 &#40;1&#12287;2&#44;80&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">DLco &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">99&#44;5 &#40;89&#12287;114&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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        "descripcion" => array:1 [
          "pt" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Dados antropom&#233;tricos&#44; composi&#231;&#227;o corporal e fun&#231;&#227;o pulmonar na amostra avaliada &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>34&#41;</p>"
        ]
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      1 => array:7 [
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          "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Os resultados s&#227;o expressos como mediana &#40;intervalos interquartis&#41; ou n&#250;mero &#40;&#37;&#41;&#46;</p><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">AFMI&#58; &#226;ngulo frontal dos membros inferiores&#59; AHC &#40;VA&#41;&#58; alinhamento horizontal da cabe&#231;a &#40;vista anterior&#41;&#59; AHP&#58; alinhamento horizontal da p&#233;lvis&#59; AJ&#58; &#226;ngulo do joelho&#59; AQ&#58; &#226;ngulo do quadril&#59; AT&#58; &#226;ngulo do tornozelo&#59; AVT&#58; alinhamento vertical do tronco&#46;</p>"
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                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Valores&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">AHC &#40;VA&#41;&nbsp;\t\t\t\t\t\t\n
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                0 => """
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                  \t\t\t\t\tvoid\n
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                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Lado direito&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">AHC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">39&#44;3 &#40;35&#44;8&#12287;45&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">39&#44;5 &#40;36&#44;5&#12287;45&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">AFMI&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">AQ&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18&#44;3 &#40;9&#44;40&#12287;24&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">23&#44;4 &#40;14&#44;5&#12287;33&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">AVT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#44;80 &#40;3&#44;50&#12287;7&#44;70&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;2&#44;50&#12287;8&#44;30&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">AHP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&#44;7 &#40;8&#44;70&#12287;19&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&#44;8 &#40;10&#44;5&#12287;19&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">AJ&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#44;90 &#40;4&#44;50&#12287;5&#44;40&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#44;90 &#40;1&#44;70&#12287;8&#44;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">AT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">83&#44;8 &#40;81&#44;2&#12287;86&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">87&#44;4 &#40;82&#44;9&#12287;90&#41;&nbsp;\t\t\t\t\t\t\n
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        ]
        "descripcion" => array:1 [
          "pt" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Valores obtidos atrav&#233;s do <span class="elsevierStyleItalic">software</span> de avalia&#231;&#227;o postural nos pacientes com asma &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>34&#41;</p>"
        ]
      ]
      2 => array:7 [
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        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">AFMI&#58; &#226;ngulo frontal dos membros inferiores&#59; AHC&#58; alinhamento horizontal da cabe&#231;a&#59; AHP&#58; alinhamento horizontal da p&#233;lvis&#59; AJ&#58; &#226;ngulo do joelho&#59; AQ&#58; &#226;ngulo do quadril&#59; AT&#58; &#226;ngulo do tornozelo&#59; IMC&#58; &#237;ndice de massa corporal&#59; MG&#58; massa gorda&#59; MM&#58; massa magra&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col">Vari&#225;veis&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">&#1023;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">&#1023;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">P</span>-valor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">IMC x AHC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;02&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">IMC x AFMI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;02&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">IMC x AHP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;54&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">MM x AQ&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#12287;0&#44;55&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">MM x AJ&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">MG &#40;&#37;&#41; x AHC&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;02&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">-0&#44;60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;002&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">-0&#44;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">MG &#40;&#37;&#41; x AHP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;66&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">MG &#40;&#37;&#41; x ATA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;04&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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        ]
        "descripcion" => array:1 [
          "pt" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Correla&#231;&#227;o entre a composi&#231;&#227;o corporal e as medidas de avalia&#231;&#227;o postural &#40;teste de correla&#231;&#227;o de Spearman mostrando somente as correla&#231;&#245;es estatisticamente significantes&#41; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>34&#41;</p>"
        ]
      ]
      3 => array:7 [
        "identificador" => "tbl0020"
        "etiqueta" => "Tabela 4"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">AHP&#58; alinhamento horizontal da p&#233;lvis&#59; AJ&#58; &#226;ngulo do joelho&#59; AQ&#58; &#226;ngulo do quadril&#59; AT&#58; &#226;ngulo do tornozelo&#59; AVT&#58; alinhamento vertical do tronco&#59; CPT&#58; capacidade pulmonar total&#59; CVF&#58; capacidade vital for&#231;ada&#59; DEMI&#58; d&#233;bito expirat&#243;rio m&#225;ximo instant&#226;neo&#59; AHC &#40;VA&#41;&#58; alinhamento horizontal da cabe&#231;a &#40;vista anterior&#41;&#59; PE<span class="elsevierStyleInf">max</span>&#58; press&#227;o expirat&#243;ria m&#225;xima&#59; PI<span class="elsevierStyleInf">max</span>&#58; press&#227;o inspirat&#243;ria m&#225;xima&#59; R<span class="elsevierStyleInf">va</span>&#58; resist&#234;ncia das vias a&#233;reas&#59; VEMS&#58; volume expirat&#243;rio m&#225;ximo no primeiro segundo&#59; VR&#58; volume residual&#46;</p>"
          "tablatextoimagen" => array:2 [
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#12287;0&#44;47&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">PE<span class="elsevierStyleInf">max</span> &#40;&#37;&#41; x AQ&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">-&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;45&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">-&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">-&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">-&nbsp;\t\t\t\t\t\t\n
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          "pt" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Correla&#231;&#227;o entre a fun&#231;&#227;o pulmonar e as medidas de avalia&#231;&#227;o postural &#40;teste de correla&#231;&#227;o de Spearman mostrando somente as correla&#231;&#245;es estatisticamente significantes&#41; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>34&#41;</p>"
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                      "titulo" => "Asthma"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "W&#46;W&#46; Busse"
                            1 => "R&#46;F&#46; Lemanske Jr&#46;"
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                    0 => array:2 [
                      "doi" => "10.1056/NEJM200102013440507"
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                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2001"
                        "volumen" => "344"
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                        "paginaFinal" => "362"
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11172168"
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                  "referenciaCompleta" => "Global initiative for Asthma &#40;GINA&#41;&#46; Pocket Guide for Asthma Management and Prevention&#46; 2010 &#91;consultado 15 Jul 2012&#93;&#46; Dispon&#237;vel em&#58; www&#46;ginasthma&#46;com"
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              "identificador" => "bib0015"
              "etiqueta" => "3"
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                0 => array:1 [
                  "referenciaCompleta" => "World Health Organization&#58; Chronic Respiratory Diseases&#46; 2011 &#91;consultado 2 Ago 2012&#93;&#46; Dispon&#237;vel em&#58; http&#58;&#47;&#47;www&#46;who&#46;int&#47;respiratory&#47;asthma&#47;en&#47;"
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              "etiqueta" => "4"
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                      "titulo" => "Postural assessment of girls between 7 and 10 years of age"
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                          "autores" => array:5 [
                            0 => "P&#46;J&#46; Penha"
                            1 => "S&#46;M&#46;A&#46; Jo&#227;o"
                            2 => "R&#46;A&#46; Casarotto"
                            3 => "C&#46;J&#46; Amino"
                            4 => "D&#46;C&#46;P&#46; Penteado"
                          ]
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                    0 => array:2 [
                      "doi" => "/S1807-59322005000100004"
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                        "fecha" => "2005"
                        "volumen" => "60"
                        "paginaInicial" => "9"
                        "paginaFinal" => "16"
                        "link" => array:1 [
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15838575"
                            "web" => "Medline"
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                ]
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              "identificador" => "bib0025"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Biophotogrammetry&#58; reliability of measurements obtained with a posture assessment software &#40;SAPO&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "J&#46;A&#46; Souza"
                            1 => "F&#46; Pasinato"
                            2 => "D&#46; Basso"
                            3 => "E&#46;C&#46;R&#46; Corr&#234;a"
                            4 => "A&#46;M&#46;T&#46; Silva"
                          ]
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