array:24 [
  "pii" => "S2173511516300896"
  "issn" => "21735115"
  "doi" => "10.1016/j.rppnen.2016.07.003"
  "estado" => "S300"
  "fechaPublicacion" => "2017-01-01"
  "aid" => "1189"
  "copyright" => "Sociedade Portuguesa de Pneumologia"
  "copyrightAnyo" => "2016"
  "documento" => "article"
  "crossmark" => 1
  "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
  "subdocumento" => "fla"
  "cita" => "Rev Port Pneumol. 2017;23:3-9"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 1506
    "formatos" => array:3 [
      "EPUB" => 203
      "HTML" => 674
      "PDF" => 629
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S2173511516300872"
    "issn" => "21735115"
    "doi" => "10.1016/j.rppnen.2016.06.009"
    "estado" => "S300"
    "fechaPublicacion" => "2017-01-01"
    "aid" => "1187"
    "copyright" => "Sociedade Portuguesa de Pneumologia"
    "documento" => "article"
    "crossmark" => 1
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "fla"
    "cita" => "Rev Port Pneumol. 2017;23:10-6"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 2188
      "formatos" => array:3 [
        "EPUB" => 221
        "HTML" => 1338
        "PDF" => 629
      ]
    ]
    "en" => array:11 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>"
      "titulo" => "Asthma and rhinitis have different genetic profiles for <span class="elsevierStyleItalic">IL13</span>&#44; <span class="elsevierStyleItalic">IL17A</span> and <span class="elsevierStyleItalic">GSTP1</span> polymorphisms"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "10"
          "paginaFinal" => "16"
        ]
      ]
      "contieneResumen" => array:1 [
        "en" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "E&#46;P&#46; Resende, A&#46; Todo-Bom, C&#46; Loureiro, A&#46; Mota Pinto, B&#46; Oliveiros, L&#46; Mesquita, H&#46;C&#46; Silva"
          "autores" => array:7 [
            0 => array:2 [
              "nombre" => "E&#46;P&#46;"
              "apellidos" => "Resende"
            ]
            1 => array:2 [
              "nombre" => "A&#46;"
              "apellidos" => "Todo-Bom"
            ]
            2 => array:2 [
              "nombre" => "C&#46;"
              "apellidos" => "Loureiro"
            ]
            3 => array:2 [
              "nombre" => "A&#46;"
              "apellidos" => "Mota Pinto"
            ]
            4 => array:2 [
              "nombre" => "B&#46;"
              "apellidos" => "Oliveiros"
            ]
            5 => array:2 [
              "nombre" => "L&#46;"
              "apellidos" => "Mesquita"
            ]
            6 => array:2 [
              "nombre" => "H&#46;C&#46;"
              "apellidos" => "Silva"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173511516300872?idApp=UINPBA00004E"
    "url" => "/21735115/0000002300000001/v1_201701210027/S2173511516300872/v1_201701210027/en/main.assets"
  ]
  "itemAnterior" => array:19 [
    "pii" => "S2173511516301312"
    "issn" => "21735115"
    "doi" => "10.1016/j.rppnen.2016.11.003"
    "estado" => "S300"
    "fechaPublicacion" => "2017-01-01"
    "aid" => "1203"
    "copyright" => "Sociedade Portuguesa de Pneumologia"
    "documento" => "simple-article"
    "crossmark" => 1
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "edi"
    "cita" => "Rev Port Pneumol. 2017;23:1-2"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 1445
      "formatos" => array:3 [
        "EPUB" => 204
        "HTML" => 673
        "PDF" => 568
      ]
    ]
    "en" => array:9 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>"
      "titulo" => "A pulmonary index able to predict peripheral muscle function in COPD"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "1"
          "paginaFinal" => "2"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "L&#46; Martinez, F&#46; Pitta"
          "autores" => array:2 [
            0 => array:2 [
              "nombre" => "L&#46;"
              "apellidos" => "Martinez"
            ]
            1 => array:2 [
              "nombre" => "F&#46;"
              "apellidos" => "Pitta"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173511516301312?idApp=UINPBA00004E"
    "url" => "/21735115/0000002300000001/v1_201701210027/S2173511516301312/v1_201701210027/en/main.assets"
  ]
  "en" => array:19 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>"
    "titulo" => "Inspiratory fraction as a marker of skeletal muscle dysfunction in patients with COPD"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "3"
        "paginaFinal" => "9"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "P&#46; Cebollero, F&#46; Zambom-Ferraresi, M&#46; Hern&#225;ndez, J&#46; Hueto, J&#46; Cascante, M&#46;M&#46; Anton"
        "autores" => array:6 [
          0 => array:3 [
            "nombre" => "P&#46;"
            "apellidos" => "Cebollero"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "F&#46;"
            "apellidos" => "Zambom-Ferraresi"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "M&#46;"
            "apellidos" => "Hern&#225;ndez"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          3 => array:3 [
            "nombre" => "J&#46;"
            "apellidos" => "Hueto"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          4 => array:3 [
            "nombre" => "J&#46;"
            "apellidos" => "Cascante"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          5 => array:4 [
            "nombre" => "M&#46;M&#46;"
            "apellidos" => "Anton"
            "email" => array:1 [
              0 => "milagros&#46;anton&#64;unavarra&#46;es"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:2 [
          0 => array:3 [
            "entidad" => "Department of Pulmonary Medicine B&#44; Complejo Hospitalario de Navarra&#44; Spain"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Department of Health Sciences&#44; Public University of Navarre&#44; Spain"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:7 [
        "identificador" => "fig0015"
        "etiqueta" => "Figure 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr3.jpeg"
            "Alto" => 1221
            "Ancho" => 1610
            "Tamanyo" => 80095
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Relationship between IC&#47;TLC ratio and total MM<span class="elsevierStyleInf">T</span> in patients with IC&#47;TLC<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>25&#37; &#40;&#9633;&#41; and IC&#47;TLC<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>25&#37; &#40;&#9632;&#41;&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Skeletal muscle dysfunction has been postulated as one of the extrapulmonary effects in patients with chronic obstructive pulmonary disease &#40;COPD&#41;&#44; resulting in reduced peripheral muscle strength and muscle mass&#46;<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">1&#44;2</span></a> Reductions in muscle force production contribute to exercise intolerance and have been associated with an increased mortality risk and a decrease in quality of life&#46;<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">3&#44;4</span></a> Lower extremity muscle power has been also recently posited as a more discriminating variable for understanding the relationship between impairments&#44; functional limitations&#44; and resultant disability with aging&#46;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">5&#44;6</span></a> Physical inactivity and systemic inflammation have been cited as factors responsible for muscle dysfunction in COPD&#46;<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">7&#44;8</span></a> Considering that reductions in peripheral muscle strength have important clinical and functional implications for COPD patients&#44; the search for effective pulmonary indices to predict peripheral muscle function is of paramount importance&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Among the pulmonary parameters&#44; forced expiratory volume in 1 second &#40;FEV<span class="elsevierStyleInf">1</span>&#41; is the most important spirometric indicator of the severity of airflow obstruction&#46; However&#44; several studies have shown the weak relationship between FEV<span class="elsevierStyleInf">1</span> and mortality&#44;<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">9&#44;10</span></a> indeed&#44; it cannot be used to detect abnormal skeletal muscle function&#46; Recently&#44; the inspiratory capacity-to total lung capacity &#40;IC&#47;TLC&#41; ratio has emerged as a better marker of mortality and functional reserve and is associated with altered exercise capacity in COPD patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">11&#44;12</span></a> Recently&#44; Ramon et al&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">13</span></a> observed that the patients with COPD with lower IC&#47;TLC experience a higher longitudinal decline in exercise capacity&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">To date&#44; only one study has investigated the role of IC&#47;TLC ratio on the muscle function in the upper extremities in this population of patients&#46; Its authors found that maximal hand grip strength was lower among IC&#47;TLC<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>25&#37; than among patients with IC&#47;TLC<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>25&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">14</span></a> However&#44; no previous studies have established the correlation between the IC&#47;TLC ratio and lower extremity muscle mass&#44; maximal strength&#44; and muscle peak power output in this patient population&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Accordingly&#44; the primary aim of the present study was to determine whether the inspiratory capacity-to-total lung capacity ratio or inspiratory fraction would be useful in predicting skeletal muscle dysfunction in the lower and upper extremities&#46; We hypothesized that patients with IC&#47;TLC<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>25&#37; would have less maximal muscle strength of the lower and upper extremities and peak power output of the lower limbs than IC&#47;TLC<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>25&#37; patients&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Materials and methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Subjects</span><p id="par0025" class="elsevierStylePara elsevierViewall">Thirty-five men with stable COPD were recruited <span class="elsevierStyleItalic">via</span> an outpatient clinic through the local pulmonologist office to participate in the study&#46; All patients had received a clinical and functional diagnosis of COPD according to the GOLD criteria &#40;stages II and III&#41;&#46; Patients presented with moderate-to-severe airways obstruction &#40;FEV<span class="elsevierStyleInf">1</span>&#47;FVC<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;7 and FEV<span class="elsevierStyleInf">1</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>80&#37; but FEV<span class="elsevierStyleInf">1</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>30&#37; predicted&#41;&#46; Inclusion criteria include&#58; &#40;1&#41; dyspnea &#40;mMMRC grades II and III&#41;&#59; &#40;2&#41; ex-smokers status&#59; and &#40;3&#41; aged 60&#8211;80 yrs&#46; Exclusion criteria include&#58; &#40;1&#41; having never smoked&#59; &#40;2&#41; exacerbation of symptoms in the preceding three months&#59; and &#40;3&#41; cardiovascular&#44; neuromuscular&#44; musculoskeletal or arthritic problems that might limit exercise tolerance&#46; The patients were informed carefully about the procedures and possible risks of the experiments&#44; as well as the benefits of the project&#44; and written consent was obtained&#46; The Research Ethics Committees of the Public University of Navarre and Virgen del Camino Hospital approved the study&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Pulmonary functional and clinical assessments</span><p id="par0030" class="elsevierStylePara elsevierViewall">Baseline assessment included&#58; &#40;1&#41; spirometry&#44; lung volumes by body plethysmography&#44; maximal inspiratory and expiratory pressure according with recommended methods&#59; &#40;2&#41; anthropometric variables&#59; &#40;3&#41; 6-min&#44; walk test &#40;6MWT&#41;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">15</span></a>&#59; and &#40;4&#41; BODE index&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Thigh muscle mass</span><p id="par0035" class="elsevierStylePara elsevierViewall">Muscle mass &#40;MM&#41; of the thigh &#40;T&#41; were assessed using magnetic resonance imaging &#40;MRI&#59; 1&#46;5<span class="elsevierStyleHsp" style=""></span>T&#59; Siemens Magnetom&#44; Germany&#41;&#46; The length of the femur &#40;Lf&#41;&#44; taken as the distance from the intercondylar notch of the femur to the superior boundary of the femoral head was measured on a coronal plane&#46; Subsequently&#44; 15 axial scans of the thigh interspaced by a distance of 1&#47;15<span class="elsevierStyleHsp" style=""></span>Lf were obtained from 1&#47;15<span class="elsevierStyleHsp" style=""></span>Lf to 15&#47;15<span class="elsevierStyleHsp" style=""></span>Lf&#46; MR imaging of both thighs was obtained&#46; Cross-sectional volumes &#40;cm<span class="elsevierStyleSup">3</span>&#41; of the thigh at 30&#37; proximal&#44; 50&#37;&#44; and 70&#37; distal of the Lf were used for further analysis&#46; The total volume &#40;cm<span class="elsevierStyleSup">3</span>&#41; of the MM<span class="elsevierStyleInf">T</span> was calculated as the combination of the 30&#44; 50&#44; and 70&#37; of the Lf&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">16</span></a></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Physical activity</span><p id="par0040" class="elsevierStylePara elsevierViewall">Habitual physical activity was evaluated using accelerometry &#40;TriTrac-R3D system&#59; WI&#44; USA&#41;&#46; The TriTrac was worn around the waist&#46; TriTrac monitoring was recorded on a minute-by-minute basis during two weekdays and two weekend days&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Lower extremity maximal strength and muscle peak power output</span><p id="par0045" class="elsevierStylePara elsevierViewall">One repetition maximum &#40;the heaviest load that could be lifted only once using the correct technique&#41; was determined for the leg press exercise &#40;1RM<span class="elsevierStyleInf">LP</span>&#41; &#40;Technogym&#44; Gambettola&#44; Italy&#41;&#46; Three-to-four subsequent attempts were made to determine 1RM&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">16</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">The subjects were instructed to exert their maximal force as fast as possible&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Muscle peak power output of the leg extensor muscles was measured during the concentric phase of leg press using the load equal to 50 and 70&#37; of 1RM&#46; An optical encoder &#40;Computer Optical Products Inc&#46;&#44; CA&#44; USA&#41; was attached to weight plates to record the position and direction of the displacement to an accuracy of 0&#46;2<span class="elsevierStyleHsp" style=""></span>mm at 1000<span class="elsevierStyleHsp" style=""></span>Hz&#46; Subjects were instructed to displace the weights as fast as possible&#46; Two testing trials were recorded and the best trial was taken for further analysis&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Upper extremity maximal strength</span><p id="par0060" class="elsevierStylePara elsevierViewall">One repetition maximum &#40;1RM&#41; was determined for seated chest press &#40;1RM<span class="elsevierStyleInf">CP</span>&#41;&#44; shoulder press&#44; and seated row &#40;Technogym&#44; Gambettola&#44; Italy&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">16</span></a></p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Systemic inflammation</span><p id="par0065" class="elsevierStylePara elsevierViewall">After 10<span class="elsevierStyleHsp" style=""></span>h of fasting and 1 day of minimal physical activity&#44; venous blood samples were obtained at rest between 8 and 10<span class="elsevierStyleHsp" style=""></span>a&#46;m&#46; from the antecubital vein for the determination of interleukin-6 &#40;IL-6&#41;&#44; tumor necrosis factor &#945; &#40;TNF-&#945;&#41;&#44; C-reactive protein &#40;CRP&#41;&#44; and plasma vascular endothelial growth factor A &#40;VEGF-A&#41; concentrations&#46; Circulating concentrations of IL-6&#44; TNF-&#945;&#44; CRP&#44; and VEGF-A were assessed in duplicate using commercially available enzyme-linked immune absorbent assay and radioimmunoassay kits&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Statistical analysis</span><p id="par0070" class="elsevierStylePara elsevierViewall">Standard statistical methods were used to calculate mean and standard deviations &#40;SPSS&#44; Chicago&#44; Illinois&#41;&#46; Statistical treatment was performed using SPSS program version 23&#46;0&#46; The assumption of a normal distribution of the data was evaluated with a Shapiro&#8211;Wilk test&#46; Cross-sectional comparisons between groups were performed by either a parametric &#40;unpaired <span class="elsevierStyleItalic">t</span>-test&#41; or a non-parametric test &#40;Mann&#8211;Whitney <span class="elsevierStyleItalic">U</span> test&#41;&#46; Pearson product-moment or Rho Spearman correlation coefficients were used to determine the association between variables of interests&#46; Due to the small size of the sample&#44; the <span class="elsevierStyleItalic">p</span>-value was simulated using bootstrap method with replacement procedure as part of the analysis&#46; A random sample was designed with replacement from the original sample to produce a new sample of the same size as the original&#46; This procedure was repeated for each sample separately&#44; and the difference in mean calculated&#46; This procedure was repeated 1000 times&#46; The <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05 criterion was used to establish statistical significance&#46; Values are reported as mean values<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>standard deviations &#40;SD&#41;&#46;</p></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Results</span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Clinical characteristics and physical activity</span><p id="par0075" class="elsevierStylePara elsevierViewall">Clinical characteristics according to the IC&#47;TLC ratio are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; The 6MWT distance was lower &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#59; bootstrap <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; and the BODE index was higher &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#59; bootstrap <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; in the IC&#47;TLC<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>25&#37; group&#46; IL-6 and CRP concentrations were higher &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#59; bootstrap <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#41; in the IC&#47;TLC<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>25&#37; group&#46; Habitual physical activity during the four days was 23&#37; lower &#40;7228<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1459<span class="elsevierStyleHsp" style=""></span>kcal <span class="elsevierStyleItalic">vs</span>&#46; 9250<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1952<span class="elsevierStyleHsp" style=""></span>kcal&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#59; bootstrap <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; in the IC&#47;TLC<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>25&#37; group than in the IC&#47;TLC<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>25&#37; group&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Thigh muscle mass</span><p id="par0080" class="elsevierStylePara elsevierViewall">MM<span class="elsevierStyleInf">T</span> volume at 30&#37;&#44; 50&#37;&#44; and 70&#37; Lf were lower &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#59; bootstrap <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; in the IC&#47;TLC<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>25&#37; group than in the IC&#47;TLC<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>25&#37; group &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; Total MM<span class="elsevierStyleInf">T</span> volume was lower &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#59; bootstrap <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; in the IC&#47;TLC<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>25&#37; group &#40;413&#46;91<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>89&#46;42<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">3</span>&#41; than in the IC&#47;TLC<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>25&#37; group &#40;575&#46;20<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>115&#46;25<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">3</span>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Lower extremity maximal dynamic strength and muscle peak power output</span><p id="par0085" class="elsevierStylePara elsevierViewall">The 1RM<span class="elsevierStyleInf">LP</span> exercise was 36&#37; lower &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;00&#59; bootstrap <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; in the IC&#47;TLC<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>25&#37; group &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; Interestingly&#44; when maximal bilateral concentric strength were expressed relative to total MM<span class="elsevierStyleInf">T</span> volume&#44; the differences between the groups disappeared &#40;0&#46;36<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;06 <span class="elsevierStyleItalic">vs</span>&#46; 0&#46;35<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;08<span class="elsevierStyleHsp" style=""></span>kg<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">&#8722;3</span>&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;70&#59; bootstrap <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;73&#41; in the IC&#47;TLC<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>25&#37; and IC&#47;TLC<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>25&#37;&#44; respectively&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">Lower extremities muscle peak power output at 50 and 70&#37; of 1 RM was 43&#37; &#40;495<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>192 <span class="elsevierStyleItalic">vs</span>&#46; 711<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>216<span class="elsevierStyleHsp" style=""></span>W&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0&#59; bootstrap <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; and 56&#37; &#40;390<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>168 <span class="elsevierStyleItalic">vs</span>&#46; 612<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>211<span class="elsevierStyleHsp" style=""></span>W&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#59; bootstrap <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; lower in the IC&#47;TLC<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>25&#37; group&#44; respectively&#46; When muscle peak power output was expressed relative to kilogram of body mass&#44; the difference was reduced to 26&#37; at the load of 50&#37; &#40;6&#46;89<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;95 <span class="elsevierStyleItalic">vs</span>&#46; 8&#46;74<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;77<span class="elsevierStyleHsp" style=""></span>W<span class="elsevierStyleHsp" style=""></span>kg<span class="elsevierStyleSup">&#8722;1</span>&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;032&#59; bootstrap <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;014&#41; and 36&#37; at the load of 70&#37; &#40;5&#46;48<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;86 <span class="elsevierStyleItalic">vs</span>&#46; 7&#46;48<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;39<span class="elsevierStyleHsp" style=""></span>W<span class="elsevierStyleHsp" style=""></span>kg<span class="elsevierStyleSup">&#8722;1</span>&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#59; bootstrap <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;002&#41; in the IC&#47;TLC<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>25&#37; than in the IC&#47;TLC<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>25&#37; group&#44; respectively&#46; When muscle peak power output was expressed relative to total MM<span class="elsevierStyleInf">T</span> volume&#44; the differences between the groups were abolished at the load of 50&#37; of 1RM &#40;1&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;3 <span class="elsevierStyleItalic">vs</span>&#46; 1&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;3<span class="elsevierStyleHsp" style=""></span>W<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">&#8722;3</span>&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;35&#59; bootstrap <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;70&#41; in the IC&#47;TLC<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>25&#37; compared with the IC&#47;TLC<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>25&#37;&#44; respectively&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Upper extremity maximal dynamic strength</span><p id="par0095" class="elsevierStylePara elsevierViewall">The 1RM<span class="elsevierStyleInf">CP</span> was 42&#37; lower &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#59; bootstrap <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; in the IC&#47;TLC<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>25&#37; group &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; Maximal dynamic strength 1RM in the seated row and shoulder press was 25&#37; lower &#40;42&#46;03<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#46;5 <span class="elsevierStyleItalic">vs</span>&#46; 52&#46;63<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;2<span class="elsevierStyleHsp" style=""></span>kg&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#59; bootstrap <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; and 29&#37; lower &#40;47&#46;86<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#46;9 <span class="elsevierStyleItalic">vs</span>&#46; 62&#46;10<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>15&#46;6<span class="elsevierStyleHsp" style=""></span>kg&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;003&#59; bootstrap <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;002&#41; in the IC&#47;TLC<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>25&#37; group than in the IC&#47;TLC<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>25&#37; group&#44; respectively&#46;</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Associations</span><p id="par0100" class="elsevierStylePara elsevierViewall">The IC&#47;TLC ratio was positively associated with total MM<span class="elsevierStyleInf">T</span> volume &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#44; 1RM<span class="elsevierStyleInf">LP</span> &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;57&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#44; 1RM<span class="elsevierStyleInf">CP</span> &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;60&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; and physical activity &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;55&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; for the entire group&#46; The FEV<span class="elsevierStyleInf">1</span> &#40;&#37; predicted&#41; was positively associated with total MM<span class="elsevierStyleInf">T</span> volume &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;46&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#41;&#44; 1RM<span class="elsevierStyleInf">LP</span> &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;43&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#41;&#44; and physical activity &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;54&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; for the entire group&#46; Moreover&#44; physical activity was positively associated with total MM<span class="elsevierStyleInf">T</span> volume &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;81&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#44; 1RM<span class="elsevierStyleInf">LP</span> &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;62&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#44; and muscle power at 50&#37; 1RM &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;78&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46; In addition&#44; a negative linear relationship was found between IL-6 and MMT volume &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;40&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;02&#41;&#44; 1RM<span class="elsevierStyleInf">LP</span> &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;50&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#41; and muscle power at 50&#37; of 1RM &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;46&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#41; for the entire group&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Discussion</span><p id="par0105" class="elsevierStylePara elsevierViewall">The salient findings of this study were that thigh muscle mass&#44; lower and upper maximal strength&#44; and leg muscle peak power output was reduced significantly in COPD patients with IC&#47;TLC<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>25&#37;&#46; In addition&#44; the IC&#47;TLC a predictor of mortality&#44; was related to thigh muscle mass and the maximal strength of lower and upper extremities&#46; The present findings suggest that IC&#47;TLC<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>25&#37; may be valued as an applicable index of skeletal muscle dysfunction in chronic obstructive pulmonary disease patients&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">An inspiratory-to total lung capacity ratio of &#8804;25&#37; is an important independent predictor of increased mortality&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">11</span></a> Recently&#44; Ramon et al&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">13</span></a> observed that the patients with COPD with lower IC&#47;TLC experience a higher longitudinal decline in exercise capacity and IC&#47;TLC and dyspnea in clinically stable patients with COPD predict their exercise capacity&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">On the basis of previous studies suggesting that lower fat-free mass and reduced grip strength is related to an IC&#47;TLC of &#8804;25&#37;&#44;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">14</span></a> we sought to determine whether an IC&#47;TLC of &#8804;25&#37; would translate to unfavorable changes in muscle mass and muscle function &#40;maximal strength and power output normalized to muscle cross-sectional area&#41; in the lower extremities&#46; Skeletal muscle weakness in the lower extremities has previously been shown to be more established with the increase of the dyspnea&#44; BODE index score&#44; and disease severity in COPD patients&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">17</span></a> Previous studies have observed that reduced thigh muscle cross-sectional area<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">3</span></a> and reduced maximal quadriceps strength&#44;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">1</span></a> which result in an impaired functional capacity&#44;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">18</span></a> is related to increased mortality<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">19</span></a> and health care utilization&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">4</span></a> Recently&#44; it has been also reported that lower extremity muscle power remains as a more discriminating variable for understanding the relationships between impairments&#44; functional limitations&#44; and resultant disability with aging&#46;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">5&#44;6</span></a> However&#44; no previous study has determined that the IC&#47;TLC ratio is a marker of muscle atrophy and reduced maximal strength and muscle power output in the lower limbs in COPD patients&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">A unique findings in this present study was that thigh muscle mass and maximal dynamic strength in the lower limbs were lower in the IC&#47;TLC<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>25&#37; group&#46; This hypothesis was strengthened by the relationship observed between the IC&#47;TLC and muscle mass &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;67&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; and lower maximal strength &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;57&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#41;&#46; In this study&#44; we extended our investigation by determining the relationship between the IC&#47;TLC<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>25&#37; group and the maximal strength of the upper limbs&#46; Indeed&#44; reduced maximal strength in the upper extremities was found in the IC&#47;TLC<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>25&#37; group&#46; This suggests that the inspiratory-to-total lung capacity ratio of &#8804;25&#37; is a surrogate marker of thigh muscle atrophy and peripheral skeletal muscle weakness&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Recently&#44; impairments in muscle peak power output in the lower extremity have emerged as a more important predictor of limitations in mobility in tasks such as rising from a chair&#44; climbing stairs&#44; habitual walking speed&#44; and even the prevention of falls&#44; than maximal muscle strength in older adults&#46;<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">20&#8211;24</span></a> To the best of our knowledge&#44; this is the first study to report the association between the IC&#47;TLC ratio and lower extremity muscle peak power in patients with COPD&#46; Our results indicate that muscle peak power output at 50 and 70&#37; of 1RM is reduced in COPD patients with an IC&#47;TLC of &#8804;25&#37;&#46; Furthermore&#44; a slowed-down capacity for muscle power output and delayed responsiveness to accidental falls in the lower and upper limbs is associated with disability&#46;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">5&#44;6</span></a> It has been documented that in older adults<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">25</span></a> with lower extremity power at high velocities &#40;40&#37; 1RM&#41; contractions were a better predictor of habitual gait velocity than power at low velocities &#40;70&#37; 1RM&#41;&#46; One of the major findings in this study was that when maximal bilateral dynamic strength and muscle power output were expressed relative to total MM<span class="elsevierStyleInf">T</span>&#44; the differences between the groups disappeared&#46; This suggests that the impairment in peripheral muscle function of the lower limbs in patients with IC&#47;TLC<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>25&#37; is mainly due to loss of muscle mass and that neural activation patterns and&#47;or twitch tension per muscle mass volume under maximal concentric actions &#40;typical leg extension actions also in normal daily activities&#41; could be rather similar between groups&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">It is no clear which physiological mechanisms explained the reductions in muscle mass in COPD patients with an IC&#47;TLC of &#8804;25&#37;&#46; In healthy older adults&#44; reduced maximal strength has been attributed to a great extent to the reduction in muscle mass&#44; which is perhaps related to alterations in hormone balance<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">26</span></a> and the decline in the quantity and intensity of physical activity&#46;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">27</span></a> In this context&#44; we postulated that lower limb muscle mass and reductions in maximal strength and peak power output might be due to elevated inflammation and the physical inactivity associated with the systemic inflammation&#46;<a class="elsevierStyleCrossRefs" href="#bib0300"><span class="elsevierStyleSup">28&#44;29</span></a> Consistent with the first part of the hypothesis&#44; we found that patients with an IC&#47;TLC of &#8804;25&#37; have elevated CRP and IL-6 levels and also&#44; we observed a negative relationship between IL-6 and muscle mass&#44; lower extremity maximal dynamic strength and leg muscle peak power output&#46; Therefore&#44; the present results might indicate that the effects of circulating IL-6 may be associated with reduced muscle mass and skeletal muscle weakness&#46; The results contradict the findings of Pleguezuelos et al&#46;<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">30</span></a> who did not observe any significant relationship between quadriceps strength and IL-6&#46; These differences might occur because of the maximum strength measurement &#40;<span class="elsevierStyleItalic">i&#46;e&#46;</span>&#44; dynamic maximum test <span class="elsevierStyleItalic">vs&#46;</span> isokinetic test&#41;&#46; Previous studies have shown that higher levels of systemic inflammation are associated with reduced physical activity in patients with COPD&#44;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">7</span></a> and the older adults who are physically inactive have higher levels of systemic inflammatory markers than those who are physically active&#46;<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">31</span></a> In support of the second part&#44; the IC&#47;TLC<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>25&#37; group demonstrated a 23&#37; lower habitual physical activity&#46; Moreover&#44; physical activity was positively associated with lower extremity maximal strength&#44; muscle power output&#44; and thigh muscle mass in the pooled group&#46; In the present study&#44; IC&#47;TLC ratio was positively associated with physical activity &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;55&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; for the entire group&#44; suggesting that those patients with higher static hyperinflation &#40;low IC&#47;TLC&#41; are less physically active&#46; A limitation of our study is that there was no direct dynamic hyperinflation during the 6MWT measurements&#46; Garcia-Rio et al&#46;<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">32</span></a> have reported that the reduced daily physical activity of patients with moderate-severe COPD might be partially explained by the development of dynamic hyperinflation&#44; regardless of the severity of the disease&#46; Garcia-Rio et al&#46;<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">32</span></a> have showed that the increase in EELV during exercise was associated with dyspnea as evaluated by the MRC scale&#46; This breathlessness could promote the limitation when the patients performed their daily physical activity&#44; increasing the physical inactivity&#46; At the same time&#44; this physical inactivity could contribute to the weakness and atrophy of the muscles&#44; leading to a vicious circle that causes more physical inactivity&#44; atrophy and skeletal muscle dysfunction&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">There are several methodological limitations in our experimental approach&#46; First&#44; as the size of the sample in the study was small&#44; we used the bootstrapping procedure as part of the statistical analysis&#44; strengthening our results&#46; Second&#44; we did not take into account patients who received corticosteroids&#46; Previous studies<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">1</span></a> have shown that quadriceps strengthened but thigh muscle mass was lower in those patients who received systemic corticosteroids&#46; However&#44; the patients in our study received the same medical treatment and exacerbation was an exclusion criteria&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">In conclusion&#44; the results of this study indicate that the inspiratory-to total lung capacity ratio may be an effective pulmonary measurement to determine muscle atrophy in the lower extremities and skeletal muscle dysfunction&#46; The relationship observed is clinically important because an IC&#47;TLC of &#8804;25&#37; can be used as an index to detect skeletal muscle weakness&#46;</p></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Ethical responsibilities</span><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Protection of human and animal subjects</span><p id="par0145" class="elsevierStylePara elsevierViewall">The authors declare that the procedures followed were in accordance with the regulations of the relevant clinical research ethics committee and with those of the Code of Ethics of the World Medical Association &#40;Declaration of Helsinki&#41;&#46;</p></span><span id="sec0100" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Confidentiality of data</span><p id="par0150" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their work center on the publication of patient data&#46;</p></span><span id="sec0105" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Right to privacy and informed consent</span><p id="par0155" class="elsevierStylePara elsevierViewall">The authors have obtained the written informed consent of the patients or subjects mentioned in the article&#46;</p></span></span><span id="sec0110" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Conflicts of interest</span><p id="par0160" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:10 [
        0 => array:3 [
          "identificador" => "xres792797"
          "titulo" => "Abstract"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "abst0005"
              "titulo" => "Background"
            ]
            1 => array:2 [
              "identificador" => "abst0010"
              "titulo" => "Methods"
            ]
            2 => array:2 [
              "identificador" => "abst0015"
              "titulo" => "Results"
            ]
            3 => array:2 [
              "identificador" => "abst0020"
              "titulo" => "Conclusion"
            ]
          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec791286"
          "titulo" => "Keywords"
        ]
        2 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        3 => array:3 [
          "identificador" => "sec0010"
          "titulo" => "Materials and methods"
          "secciones" => array:8 [
            0 => array:2 [
              "identificador" => "sec0015"
              "titulo" => "Subjects"
            ]
            1 => array:2 [
              "identificador" => "sec0020"
              "titulo" => "Pulmonary functional and clinical assessments"
            ]
            2 => array:2 [
              "identificador" => "sec0025"
              "titulo" => "Thigh muscle mass"
            ]
            3 => array:2 [
              "identificador" => "sec0030"
              "titulo" => "Physical activity"
            ]
            4 => array:2 [
              "identificador" => "sec0035"
              "titulo" => "Lower extremity maximal strength and muscle peak power output"
            ]
            5 => array:2 [
              "identificador" => "sec0040"
              "titulo" => "Upper extremity maximal strength"
            ]
            6 => array:2 [
              "identificador" => "sec0045"
              "titulo" => "Systemic inflammation"
            ]
            7 => array:2 [
              "identificador" => "sec0050"
              "titulo" => "Statistical analysis"
            ]
          ]
        ]
        4 => array:3 [
          "identificador" => "sec0055"
          "titulo" => "Results"
          "secciones" => array:5 [
            0 => array:2 [
              "identificador" => "sec0060"
              "titulo" => "Clinical characteristics and physical activity"
            ]
            1 => array:2 [
              "identificador" => "sec0065"
              "titulo" => "Thigh muscle mass"
            ]
            2 => array:2 [
              "identificador" => "sec0070"
              "titulo" => "Lower extremity maximal dynamic strength and muscle peak power output"
            ]
            3 => array:2 [
              "identificador" => "sec0075"
              "titulo" => "Upper extremity maximal dynamic strength"
            ]
            4 => array:2 [
              "identificador" => "sec0080"
              "titulo" => "Associations"
            ]
          ]
        ]
        5 => array:2 [
          "identificador" => "sec0085"
          "titulo" => "Discussion"
        ]
        6 => array:3 [
          "identificador" => "sec0090"
          "titulo" => "Ethical responsibilities"
          "secciones" => array:3 [
            0 => array:2 [
              "identificador" => "sec0095"
              "titulo" => "Protection of human and animal subjects"
            ]
            1 => array:2 [
              "identificador" => "sec0100"
              "titulo" => "Confidentiality of data"
            ]
            2 => array:2 [
              "identificador" => "sec0105"
              "titulo" => "Right to privacy and informed consent"
            ]
          ]
        ]
        7 => array:2 [
          "identificador" => "sec0110"
          "titulo" => "Conflicts of interest"
        ]
        8 => array:2 [
          "identificador" => "xack265527"
          "titulo" => "Acknowledgments"
        ]
        9 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2016-04-18"
    "fechaAceptado" => "2016-07-21"
    "PalabrasClave" => array:1 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec791286"
          "palabras" => array:6 [
            0 => "Chronic obstructive pulmonary disease"
            1 => "Inspiratory fraction"
            2 => "Muscle mass"
            3 => "Muscle strength"
            4 => "Limb muscle dysfunction"
            5 => "Muscle power"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:1 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">An inspiratory capacity to total lung capacity &#40;IC&#47;TLC&#41; ratio of &#8804;25&#37; has emerged as a better marker of mortality in chronic obstructive pulmonary disease &#40;COPD&#41; patients&#46; The relationship among the IC&#47;TLC ratio to lower extremity skeletal muscle function remains unknown&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Thirty-five men with moderate to severe COPD were divided into those with IC&#47;TLC<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>25&#37; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>16&#41; and &#62;25&#37; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>19&#41;&#46; The subjects were tested for thigh muscle mass volume &#40;MMT&#41;&#44; maximal strength&#44; power output of the lower extremities&#44; and physical activity&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Total MMT in the IC&#47;TLC<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>25&#37; group was significantly lower &#40;413&#46;91<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>89&#46;42<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">3</span>&#41; &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; than in the IC&#47;TLC<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>25&#37; group &#40;575&#46;20<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#46;76<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">3</span>&#41;&#46; In the IC&#47;TLC<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>25&#37; group&#44; maximal strength of the lower extremities and muscle peak power output of the lower extremities were 36&#8211;56&#37; lower &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#41; than among the patients in the IC&#47;TLC<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>25&#37; group&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">IC&#47;TLC<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>25&#37; is associated with reduced maximal strength and peak power output of the lower extremities&#46; IC&#47;TLC<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>25&#37; may have an important clinical relevance as an index to determine peripheral muscle dysfunction&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Background"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Methods"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusion"
          ]
        ]
      ]
    ]
    "multimedia" => array:4 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1179
            "Ancho" => 1613
            "Tamanyo" => 77011
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Thigh muscle mass &#40;MM<span class="elsevierStyleInf">T</span>&#41; at 30&#37;&#44; 50&#37;&#44; and 70&#37; Lf according to IC&#47;TLC ratio&#46; Data are presented as means<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD&#46; &#42;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>0&#46;001 IC&#47;TLC<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>25&#37; <span class="elsevierStyleItalic">vs&#46;</span> IC&#47;TLC<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>25&#37;&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 1200
            "Ancho" => 1623
            "Tamanyo" => 68341
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Lower and upper body muscle maximal dynamic strength&#46; Maximal bilateral concentric 1RM in leg press and seated chest press in IC&#47;TLC<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>25&#37; and IC&#47;TLC<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>25&#37; group&#46; Data are presented as means<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD&#46; &#42;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001 IC&#47;TLC<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>25&#37; <span class="elsevierStyleItalic">vs&#46;</span> IC&#47;TLC<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>25&#37;&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "fig0015"
        "etiqueta" => "Figure 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr3.jpeg"
            "Alto" => 1221
            "Ancho" => 1610
            "Tamanyo" => 80095
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Relationship between IC&#47;TLC ratio and total MM<span class="elsevierStyleInf">T</span> in patients with IC&#47;TLC<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>25&#37; &#40;&#9633;&#41; and IC&#47;TLC<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>25&#37; &#40;&#9632;&#41;&#46;</p>"
        ]
      ]
      3 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Values expressed in mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD&#46; BMI<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>body mass index&#59; FEV<span class="elsevierStyleInf">1</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>forced expiratory volume in one second&#59; FVC<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>forced vital capacity&#59; TLC<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>total lung capacity&#59; RV<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>residual volume&#59; IC<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>inspiratory capacity&#59; <span class="elsevierStyleItalic">P</span>I&#44;max<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>maximal inspiratory pressure&#59; <span class="elsevierStyleItalic">P</span>E&#44;max<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>maximal expiratory pressure&#59; SpO<span class="elsevierStyleInf">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>arterial oxygen saturation measured by pulse oximetry&#59; Change SpO<span class="elsevierStyleInf">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>SpO<span class="elsevierStyleInf">2</span> before minus SpO<span class="elsevierStyleInf">2</span> at the end of 6MWT&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <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="" valign="top" scope="col" style="border-bottom: 2px solid black">&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">IC&#47;TLC<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>25&#37;&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">IC&#47;TLC<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>25&#37;&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>-Value&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">Bootstrap<br><span class="elsevierStyleItalic">p</span>-Value&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-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Subjects&#44; <span class="elsevierStyleItalic">n</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age&#44; y&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">71<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">68<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Body mass&#44; kg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">70&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">83&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>18&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;03&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Height&#44; cm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">166<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">167<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;70&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;76&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">BMI&#44; kg<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">&#8722;2</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">29&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">FEV<span class="elsevierStyleInf">1</span>&#44; &#37; predicted&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">37&#46;67<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#46;92&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">48&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#46;03&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;002&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">FVC&#44; &#37; predicted&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">67&#46;02<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>14&#46;14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">77&#46;69<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&#46;39&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;06&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">FEV<span class="elsevierStyleInf">1</span>&#47;FVC&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">41<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">45<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">TLC&#44; &#37; predicted&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">120&#46;09<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>21&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">115&#46;53<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>18&#46;13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;52&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">RV&#44; &#37; predicted&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">177&#46;69<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>41&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">153&#46;24<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;75&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;07&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;06&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">RV&#47;TLC&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">61&#46;95<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#46;36&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">52&#46;21<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#46;98&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">IC&#44; L&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;54<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;52<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;03&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">IC&#47;TLC&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;96&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">35&#46;47<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#46;57&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">P</span>I&#44;max&#44; cmH<span class="elsevierStyleInf">2</span>0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">69&#46;38<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">89&#46;16<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>25&#46;67&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;02&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">P</span>E&#44;max&#44; cmH<span class="elsevierStyleInf">2</span>0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">89&#46;81<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>37&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">101&#46;11<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>28&#46;57&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">6MWT&#44; m&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">409<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>108&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">528<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>74&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Final Borg dyspnea in the 6MWT&#44; score&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;34<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;11<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;84&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;76&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;76&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Final SpO<span class="elsevierStyleInf">2</span> in the 6MWT &#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">82<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#46;54&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">83<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;68&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;70&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Change SpO<span class="elsevierStyleInf">2</span> in 6MWT&#44; points&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#46;87<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#46;24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#46;88<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;69&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;68&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">BODE index&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">IL-6&#44; &#961;g<span class="elsevierStyleHsp" style=""></span>mL<span class="elsevierStyleSup">&#8722;1</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14&#46;42<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>17&#46;14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;86<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">VEGF-A&#44; &#961;g<span class="elsevierStyleHsp" style=""></span>mL<span class="elsevierStyleSup">&#8722;1</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">168&#46;21<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>295&#46;09&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">82&#46;36<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>70&#46;36&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">TNF-&#945;&#44; &#961;g<span class="elsevierStyleHsp" style=""></span>mL<span class="elsevierStyleSup">&#8722;1</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&#46;38<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#46;83&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&#46;98<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;07&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;54&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;53&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">CRP&#44; mg<span class="elsevierStyleHsp" style=""></span>dL<span class="elsevierStyleSup">&#8722;1</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;33<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;47&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;59<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;64&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1325778.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Clinical&#44; anthropometric characteristics and inflammatory markers in patients with chronic obstructive pulmonary disease according to inspiratory capacity to total lung capacity ratio&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:32 [
            0 => array:3 [
              "identificador" => "bib0165"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Peripheral muscle weakness in patients with chronic obstructive pulmonary disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46; Bernard"
                            1 => "P&#46; Leblanc"
                            2 => "F&#46; Whittom"
                            3 => "G&#46; Carrier"
                            4 => "J&#46; Jobin"
                            5 => "R&#46; Belleau"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/ajrccm.158.2.9711023"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "1998"
                        "volumen" => "158"
                        "paginaInicial" => "629"
                        "paginaFinal" => "634"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9700144"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0170"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Myopathological features in skeletal muscle of patients with chronic obstructive pulmonary disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "H&#46;R&#46; Gosker"
                            1 => "B&#46; Kubat"
                            2 => "G&#46; Schaart"
                            3 => "G&#46;J&#46; Van der Vusse"
                            4 => "E&#46;F&#46; Wouters"
                            5 => "A&#46;M&#46; Schols"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Respir J"
                        "fecha" => "2003"
                        "volumen" => "22"
                        "paginaInicial" => "280"
                        "paginaFinal" => "285"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12952261"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0175"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Midthigh muscle cross-sectional area is better predictor of mortality than body mass index in patients with chronic obstructive pulmonary disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "K&#46; Marquis"
                            1 => "R&#46; Debigar&#233;"
                            2 => "Y&#46; Lacasse"
                            3 => "P&#46; LeBlanc"
                            4 => "J&#46; Jobin"
                            5 => "G&#46; Carrier"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/rccm.2107031"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "2002"
                        "volumen" => "166"
                        "paginaInicial" => "809"
                        "paginaFinal" => "813"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12231489"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0180"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Muscle weakness is related to utilization of health care resources in COPD patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "M&#46; Decramer"
                            1 => "R&#46; Gosselink"
                            2 => "T&#46; Troosters"
                            3 => "M&#46; Verschueren"
                            4 => "G&#46; Evers"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Respir J"
                        "fecha" => "1997"
                        "volumen" => "10"
                        "paginaInicial" => "417"
                        "paginaFinal" => "423"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9042643"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0185"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Skeletal muscle power and functioning in older adults"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "K&#46;F&#46; Reid"
                            1 => "R&#46;A&#46; Fielding"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Exerc Sport Sci Rev"
                        "fecha" => "2012"
                        "volumen" => "40"
                        "paginaInicial" => "1"
                        "paginaFinal" => "12"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0190"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "How to simultaneously optimize muscle strength&#44; power&#44; functional capacity&#44; and cardiovascular gains in the elderly&#58; an update"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "E&#46;L&#46; Cadore"
                            1 => "M&#46; Izquierdo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s11357-012-9503-x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Age"
                        "fecha" => "2013"
                        "volumen" => "35"
                        "paginaInicial" => "2329"
                        "paginaFinal" => "2344"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23288690"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0195"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Extrapulmonary effects of chronic obstructive pulmonary disease on physical activity&#58; a cross-sectional study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "H&#46; Watz"
                            1 => "B&#46; Waschki"
                            2 => "C&#46; Boeheme"
                            3 => "M&#46; Claussen"
                            4 => "T&#46; Meyer"
                            5 => "H&#46; Magnussen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/rccm.200707-1011OC"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "2008"
                        "volumen" => "177"
                        "paginaInicial" => "743"
                        "paginaFinal" => "751"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18048807"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0200"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Characteristic of physical activity in daily life in chronic obstructive pulmonary disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "F&#46; Pitta"
                            1 => "T&#46; Troosters"
                            2 => "M&#46;A&#46; Spruit"
                            3 => "V&#46;S&#46; Probst"
                            4 => "M&#46; Decramer"
                            5 => "R&#46; Gosselink"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/rccm.200407-855OC"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "2005"
                        "volumen" => "171"
                        "paginaInicial" => "972"
                        "paginaFinal" => "977"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15665324"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0205"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pulmonary function is a long-term predictor of mortality in the general population&#58; 29-year follow-up of the Buffalo Health Study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "H&#46;J&#46; Sch&#252;nemann"
                            1 => "J&#46; Dorn"
                            2 => "B&#46;J&#46; Grant"
                            3 => "W&#46; Winkelstein Jr&#46;"
                            4 => "M&#46; Trevisan"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Chest"
                        "fecha" => "2000"
                        "volumen" => "118"
                        "paginaInicial" => "656"
                        "paginaFinal" => "664"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10988186"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0210"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Predictors of mortality in COPD"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "B&#46;R&#46; Celli"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.rmed.2009.12.017"
                      "Revista" => array:6 [
                        "tituloSerie" => "Respir Med"
                        "fecha" => "2010"
                        "volumen" => "104"
                        "paginaInicial" => "773"
                        "paginaFinal" => "779"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20417082"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0215"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Inspiratory-to-total lung capacity ratio predicts mortality in patients with chronic obstructive pulmonary disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "C&#46; Casanova"
                            1 => "C&#46; Cote"
                            2 => "J&#46;P&#46; de Torres"
                            3 => "A&#46; Aguirre-Jaime"
                            4 => "J&#46;M&#46; Marin"
                            5 => "V&#46; Pinto-Plata"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/rccm.200407-867OC"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "2005"
                        "volumen" => "171"
                        "paginaInicial" => "591"
                        "paginaFinal" => "597"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15591470"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0220"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Inspiratory fraction and exercise impairment in COPD patients GOLD stages II&#8211;III"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46;L&#46;P&#46; Alburquerque"
                            1 => "L&#46;E&#46; Nery"
                            2 => "D&#46;S&#46; Villa&#231;a"
                            3 => "T&#46;Y&#46; Machado"
                            4 => "C&#46;C&#46; Oliveira"
                            5 => "A&#46;T&#46; Paes"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1183/09031936.06.00040506"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Respir J"
                        "fecha" => "2006"
                        "volumen" => "28"
                        "paginaInicial" => "939"
                        "paginaFinal" => "944"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16870665"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0225"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Inspiratory capacity-to-total lung capacity ratio and dyspnoea predict exercise capacity decline in COPD"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46;A&#46; Ramon"
                            1 => "J&#46; Ferrer"
                            2 => "E&#46; Gimeno-Santos"
                            3 => "D&#46; Donaire-Gonzalez"
                            4 => "E&#46; Rodr&#237;guez"
                            5 => "E&#46; Balcells"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/resp.12723"
                      "Revista" => array:6 [
                        "tituloSerie" => "Respirology"
                        "fecha" => "2016"
                        "volumen" => "21"
                        "paginaInicial" => "476"
                        "paginaFinal" => "482"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26714424"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0230"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effects of hyperinflation on the oxygen pulse as a marker of cardiac performance in COPD"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "C&#46; Vassaux"
                            1 => "L&#46; Torre-Bouscoulet"
                            2 => "Z&#46; Zeineldine"
                            3 => "F&#46; Cortopassi"
                            4 => "H&#46; Paz-D&#237;az"
                            5 => "B&#46;R&#46; Celli"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1183/09031936.00151707"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Respir J"
                        "fecha" => "2008"
                        "volumen" => "32"
                        "paginaInicial" => "1275"
                        "paginaFinal" => "1282"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18550609"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0235"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "ATS statement&#58; guidelines for the six-minute walk test"
                      "autores" => array:1 [
                        0 => array:2 [
                          "colaboracion" => "ATS"
                          "etal" => false
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/ajrccm.166.1.at1102"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "2002"
                        "volumen" => "166"
                        "paginaInicial" => "111"
                        "paginaFinal" => "117"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12091180"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0240"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effects of strength training on muscle fatigue mapping from surface EMG and blood metabolites"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Izquierdo"
                            1 => "M&#46; Gonz&#225;lez-Izal"
                            2 => "I&#46; Navarro-Amezqueta"
                            3 => "J&#46;A&#46; Calbet"
                            4 => "J&#46; Iba&#241;ez"
                            5 => "A&#46; Malanda"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1249/MSS.0b013e3181edfa96"
                      "Revista" => array:6 [
                        "tituloSerie" => "Med Sci Sports Exerc"
                        "fecha" => "2011"
                        "volumen" => "43"
                        "paginaInicial" => "303"
                        "paginaFinal" => "311"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20581711"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0245"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The prevalence of quadriceps weakness in COPD and the relationship with disease severity"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;M&#46; Seymour"
                            1 => "M&#46;A&#46; Spruit"
                            2 => "N&#46;S&#46; Hopkinson"
                            3 => "S&#46;A&#46; Natanek"
                            4 => "W&#46;D&#46; Man"
                            5 => "A&#46; Jackson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1183/09031936.00104909"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Respir J"
                        "fecha" => "2010"
                        "volumen" => "36"
                        "paginaInicial" => "81"
                        "paginaFinal" => "88"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19897554"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0250"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Peripheral muscle weakness contributes to exercise limitation in COPD"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "R&#46; Gosselink"
                            1 => "T&#46; Troosters"
                            2 => "M&#46; Decramer"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/ajrccm.153.3.8630582"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "1996"
                        "volumen" => "153"
                        "paginaInicial" => "976"
                        "paginaFinal" => "980"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8630582"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0255"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Quadriceps strength predicts mortality in patients with moderate to severe chronic obstructive pulmonary disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "E&#46;B&#46; Swallow"
                            1 => "D&#46; Reyes"
                            2 => "N&#46;S&#46; Hopkinson"
                            3 => "W&#46;D&#46; Man"
                            4 => "R&#46; Porcher"
                            5 => "E&#46;J&#46; Cetti"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/thx.2006.062026"
                      "Revista" => array:6 [
                        "tituloSerie" => "Thorax"
                        "fecha" => "2007"
                        "volumen" => "62"
                        "paginaInicial" => "115"
                        "paginaFinal" => "120"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17090575"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0260"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Maximal and explosive force production capacity and balance performance in men of different ages"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "M&#46; Izquierdo"
                            1 => "X&#46; Aguado"
                            2 => "R&#46; Gonzalez"
                            3 => "J&#46;L&#46; L&#243;pez"
                            4 => "K&#46; H&#228;kkinen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Eur J Appl Physiol"
                        "fecha" => "1999"
                        "volumen" => "79"
                        "paginaInicial" => "260"
                        "paginaFinal" => "267"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0265"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Maximal strength and power characteristics in isometric and dynamic actions of the upper and lower extremities in middle-aged and older men"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Izquierdo"
                            1 => "J&#46; Iba&#241;ez"
                            2 => "E&#46; Gorostiaga"
                            3 => "M&#46; Garrues"
                            4 => "A&#46; Zu&#241;iga"
                            5 => "A&#46; Ant&#243;n"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1046/j.1365-201x.1999.00590.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Acta Physiol Scand"
                        "fecha" => "1999"
                        "volumen" => "167"
                        "paginaInicial" => "57"
                        "paginaFinal" => "58"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10519978"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0270"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Leg extensor power and functional performance in very old men and women"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "E&#46;J&#46; Bassey"
                            1 => "M&#46;A&#46; Fiatarone"
                            2 => "E&#46;F&#46; O&#8217;Neill"
                            3 => "M&#46; Kelly"
                            4 => "W&#46;J&#46; Evans"
                            5 => "L&#46;A&#46; Lipsitz"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Sci"
                        "fecha" => "1992"
                        "volumen" => "82"
                        "paginaInicial" => "321"
                        "paginaFinal" => "327"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1312417"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0275"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A comparison of leg power and leg strength within the InCHIANTI study&#58; which influences mobility more&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "J&#46;F&#46; Bean"
                            1 => "S&#46;G&#46; Leveille"
                            2 => "D&#46;K&#46; Kiely"
                            3 => "S&#46; Bandinelli"
                            4 => "J&#46;M&#46; Guralnik"
                            5 => "L&#46; Ferruci"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Gerontol A Biol Sci Med Sci"
                        "fecha" => "2003"
                        "volumen" => "58"
                        "paginaInicial" => "728"
                        "paginaFinal" => "733"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12902531"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib0280"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effect of high versus low-velocity resistance training on muscular fitness and functional performance in older men"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "M&#46; Bottaro"
                            1 => "S&#46;N&#46; Machado"
                            2 => "W&#46; Nogueira"
                            3 => "R&#46; Scales"
                            4 => "J&#46; Veloso"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00421-006-0343-1"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Appl Physiol"
                        "fecha" => "2007"
                        "volumen" => "99"
                        "paginaInicial" => "257"
                        "paginaFinal" => "264"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17146693"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib0285"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Impact of muscle power and force on gait speed in disabled older men and women"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "A&#46; Cuoco"
                            1 => "D&#46;M&#46; Callahan"
                            2 => "S&#46; Sayers"
                            3 => "W&#46;R&#46; Frontera"
                            4 => "J&#46; Bean"
                            5 => "R&#46;A&#46; Fielding"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Gerontol A Biol Sci Med Sci"
                        "fecha" => "2004"
                        "volumen" => "59"
                        "paginaInicial" => "1200"
                        "paginaFinal" => "1206"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15602076"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib0290"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Serum hormones and strength development during strength training in middle-aged and elderly males and females"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "K&#46; H&#228;kkinen"
                            1 => "A&#46; Pakarinen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1748-1716.1994.tb09678.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Acta Physiol Scand"
                        "fecha" => "1994"
                        "volumen" => "150"
                        "paginaInicial" => "211"
                        "paginaFinal" => "219"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8191900"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib0295"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The physical activity of healthy and chronically ill adults in Finland at work&#44; at leisure and during commuting"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "E&#46; M&#228;lki&#228;"
                            1 => "O&#46; Impivaara"
                            2 => "M&#46; Heli&#246;vaara"
                            3 => "J&#46; Maatela"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Scand J Med Sci Sports"
                        "fecha" => "1994"
                        "volumen" => "4"
                        "paginaInicial" => "82"
                        "paginaFinal" => "87"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib0300"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Systemic effects of chronic obstructive pulmonary disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "A&#46;G&#46;N&#46; Agusti"
                            1 => "A&#46; Noguera"
                            2 => "J&#46; Sauleda"
                            3 => "E&#46; Sala"
                            4 => "J&#46; Pons"
                            5 => "X&#46; Busquests"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Respir J"
                        "fecha" => "2003"
                        "volumen" => "21"
                        "paginaInicial" => "347"
                        "paginaFinal" => "360"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12608452"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib0305"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Skeletal muscle weakness&#44; reduced exercise tolerance&#44; and COPD&#58; is systemic inflammation the missing link"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "D&#46;D&#46; Sin"
                            1 => "S&#46;F&#46; Man"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/thx.2005.044941"
                      "Revista" => array:6 [
                        "tituloSerie" => "Thorax"
                        "fecha" => "2006"
                        "volumen" => "61"
                        "paginaInicial" => "1"
                        "paginaFinal" => "3"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16396949"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib0310"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Muscular dysfunction in COPD&#58; Systemic effect or deconditioning"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "E&#46; Pleguezuelos"
                            1 => "C&#46; Esquinas"
                            2 => "E&#46; Moreno"
                            3 => "L&#46; Guirao"
                            4 => "J&#46; Ortiz"
                            5 => "J&#46; Garcia-Alsina"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00408-015-9838-z"
                      "Revista" => array:6 [
                        "tituloSerie" => "Lung"
                        "fecha" => "2016"
                        "volumen" => "194"
                        "paginaInicial" => "249"
                        "paginaFinal" => "257"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26743191"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            30 => array:3 [
              "identificador" => "bib0315"
              "etiqueta" => "31"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Physical activity and hemostatic and inflammatory variables in elderly men"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "S&#46;G&#46; Wannamethee"
                            1 => "G&#46;D&#46; Lowe"
                            2 => "P&#46;H&#46; Whincup"
                            3 => "A&#46; Rumley"
                            4 => "M&#46; Walker"
                            5 => "L&#46; Lennon"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Circulation"
                        "fecha" => "2002"
                        "volumen" => "105"
                        "paginaInicial" => "1785"
                        "paginaFinal" => "1790"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11956120"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            31 => array:3 [
              "identificador" => "bib0320"
              "etiqueta" => "32"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Daily physical activity in patients with chronic obstructive pulmonary disease is mainly associated with dynamic hyperinflation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "F&#46; Garcia-Rio"
                            1 => "V&#46; Lores"
                            2 => "O&#46; Mediano"
                            3 => "B&#46; Rojo"
                            4 => "A&#46; Hernanz"
                            5 => "E&#46; L&#243;pez-Collazo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/rccm.200812-1873OC"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "2009"
                        "volumen" => "180"
                        "paginaInicial" => "506"
                        "paginaFinal" => "512"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19542481"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
    "agradecimientos" => array:1 [
      0 => array:4 [
        "identificador" => "xack265527"
        "titulo" => "Acknowledgments"
        "texto" => "<p id="par0165" class="elsevierStylePara elsevierViewall">This study was conducted with the support of the <span class="elsevierStyleGrantSponsor" id="gs1">Spanish Ministry of Education and Science</span> &#40;Plan Nacional I<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>D<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>i 2004-2007 y 2008-20011 Strategic action&#58; &#8220;Sport and physical education&#8221; Ref&#58; <span class="elsevierStyleGrantNumber" refid="gs1">DEP2007-73220</span>&#44; <span class="elsevierStyleGrantNumber" refid="gs1">DEP2011-30042</span>&#41; and <span class="elsevierStyleGrantSponsor" id="gs2">Health Sciences Department of Government of Navarre</span>&#46;</p>"
        "vista" => "all"
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/21735115/0000002300000001/v1_201701210027/S2173511516300896/v1_201701210027/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "9710"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Original articles"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/21735115/0000002300000001/v1_201701210027/S2173511516300896/v1_201701210027/en/main.pdf?idApp=UINPBA00004E&text.app=https://journalpulmonology.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173511516300896?idApp=UINPBA00004E"
]
Share
Journal Information

Statistics

Follow this link to access the full text of the article

Original article
Inspiratory fraction as a marker of skeletal muscle dysfunction in patients with COPD
P. Cebolleroa, F. Zambom-Ferraresib, M. Hernándeza, J. Huetoa, J. Cascantea, M.M. Antonb,
Corresponding author
milagros.anton@unavarra.es

Corresponding author.
a Department of Pulmonary Medicine B, Complejo Hospitalario de Navarra, Spain
b Department of Health Sciences, Public University of Navarre, Spain
Read
1001
Times
was read the article
540
Total PDF
461
Total HTML
Share statistics
 array:24 [
  "pii" => "S2173511516300896"
  "issn" => "21735115"
  "doi" => "10.1016/j.rppnen.2016.07.003"
  "estado" => "S300"
  "fechaPublicacion" => "2017-01-01"
  "aid" => "1189"
  "copyright" => "Sociedade Portuguesa de Pneumologia"
  "copyrightAnyo" => "2016"
  "documento" => "article"
  "crossmark" => 1
  "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
  "subdocumento" => "fla"
  "cita" => "Rev Port Pneumol. 2017;23:3-9"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 1506
    "formatos" => array:3 [
      "EPUB" => 203
      "HTML" => 674
      "PDF" => 629
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S2173511516300872"
    "issn" => "21735115"
    "doi" => "10.1016/j.rppnen.2016.06.009"
    "estado" => "S300"
    "fechaPublicacion" => "2017-01-01"
    "aid" => "1187"
    "copyright" => "Sociedade Portuguesa de Pneumologia"
    "documento" => "article"
    "crossmark" => 1
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "fla"
    "cita" => "Rev Port Pneumol. 2017;23:10-6"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 2188
      "formatos" => array:3 [
        "EPUB" => 221
        "HTML" => 1338
        "PDF" => 629
      ]
    ]
    "en" => array:11 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>"
      "titulo" => "Asthma and rhinitis have different genetic profiles for <span class="elsevierStyleItalic">IL13</span>&#44; <span class="elsevierStyleItalic">IL17A</span> and <span class="elsevierStyleItalic">GSTP1</span> polymorphisms"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "10"
          "paginaFinal" => "16"
        ]
      ]
      "contieneResumen" => array:1 [
        "en" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "E&#46;P&#46; Resende, A&#46; Todo-Bom, C&#46; Loureiro, A&#46; Mota Pinto, B&#46; Oliveiros, L&#46; Mesquita, H&#46;C&#46; Silva"
          "autores" => array:7 [
            0 => array:2 [
              "nombre" => "E&#46;P&#46;"
              "apellidos" => "Resende"
            ]
            1 => array:2 [
              "nombre" => "A&#46;"
              "apellidos" => "Todo-Bom"
            ]
            2 => array:2 [
              "nombre" => "C&#46;"
              "apellidos" => "Loureiro"
            ]
            3 => array:2 [
              "nombre" => "A&#46;"
              "apellidos" => "Mota Pinto"
            ]
            4 => array:2 [
              "nombre" => "B&#46;"
              "apellidos" => "Oliveiros"
            ]
            5 => array:2 [
              "nombre" => "L&#46;"
              "apellidos" => "Mesquita"
            ]
            6 => array:2 [
              "nombre" => "H&#46;C&#46;"
              "apellidos" => "Silva"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173511516300872?idApp=UINPBA00004E"
    "url" => "/21735115/0000002300000001/v1_201701210027/S2173511516300872/v1_201701210027/en/main.assets"
  ]
  "itemAnterior" => array:19 [
    "pii" => "S2173511516301312"
    "issn" => "21735115"
    "doi" => "10.1016/j.rppnen.2016.11.003"
    "estado" => "S300"
    "fechaPublicacion" => "2017-01-01"
    "aid" => "1203"
    "copyright" => "Sociedade Portuguesa de Pneumologia"
    "documento" => "simple-article"
    "crossmark" => 1
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "edi"
    "cita" => "Rev Port Pneumol. 2017;23:1-2"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 1445
      "formatos" => array:3 [
        "EPUB" => 204
        "HTML" => 673
        "PDF" => 568
      ]
    ]
    "en" => array:9 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>"
      "titulo" => "A pulmonary index able to predict peripheral muscle function in COPD"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "1"
          "paginaFinal" => "2"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "L&#46; Martinez, F&#46; Pitta"
          "autores" => array:2 [
            0 => array:2 [
              "nombre" => "L&#46;"
              "apellidos" => "Martinez"
            ]
            1 => array:2 [
              "nombre" => "F&#46;"
              "apellidos" => "Pitta"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173511516301312?idApp=UINPBA00004E"
    "url" => "/21735115/0000002300000001/v1_201701210027/S2173511516301312/v1_201701210027/en/main.assets"
  ]
  "en" => array:19 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>"
    "titulo" => "Inspiratory fraction as a marker of skeletal muscle dysfunction in patients with COPD"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "3"
        "paginaFinal" => "9"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "P&#46; Cebollero, F&#46; Zambom-Ferraresi, M&#46; Hern&#225;ndez, J&#46; Hueto, J&#46; Cascante, M&#46;M&#46; Anton"
        "autores" => array:6 [
          0 => array:3 [
            "nombre" => "P&#46;"
            "apellidos" => "Cebollero"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "F&#46;"
            "apellidos" => "Zambom-Ferraresi"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "M&#46;"
            "apellidos" => "Hern&#225;ndez"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          3 => array:3 [
            "nombre" => "J&#46;"
            "apellidos" => "Hueto"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          4 => array:3 [
            "nombre" => "J&#46;"
            "apellidos" => "Cascante"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          5 => array:4 [
            "nombre" => "M&#46;M&#46;"
            "apellidos" => "Anton"
            "email" => array:1 [
              0 => "milagros&#46;anton&#64;unavarra&#46;es"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:2 [
          0 => array:3 [
            "entidad" => "Department of Pulmonary Medicine B&#44; Complejo Hospitalario de Navarra&#44; Spain"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Department of Health Sciences&#44; Public University of Navarre&#44; Spain"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:7 [
        "identificador" => "fig0015"
        "etiqueta" => "Figure 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr3.jpeg"
            "Alto" => 1221
            "Ancho" => 1610
            "Tamanyo" => 80095
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Relationship between IC&#47;TLC ratio and total MM<span class="elsevierStyleInf">T</span> in patients with IC&#47;TLC<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>25&#37; &#40;&#9633;&#41; and IC&#47;TLC<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>25&#37; &#40;&#9632;&#41;&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Skeletal muscle dysfunction has been postulated as one of the extrapulmonary effects in patients with chronic obstructive pulmonary disease &#40;COPD&#41;&#44; resulting in reduced peripheral muscle strength and muscle mass&#46;<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">1&#44;2</span></a> Reductions in muscle force production contribute to exercise intolerance and have been associated with an increased mortality risk and a decrease in quality of life&#46;<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">3&#44;4</span></a> Lower extremity muscle power has been also recently posited as a more discriminating variable for understanding the relationship between impairments&#44; functional limitations&#44; and resultant disability with aging&#46;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">5&#44;6</span></a> Physical inactivity and systemic inflammation have been cited as factors responsible for muscle dysfunction in COPD&#46;<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">7&#44;8</span></a> Considering that reductions in peripheral muscle strength have important clinical and functional implications for COPD patients&#44; the search for effective pulmonary indices to predict peripheral muscle function is of paramount importance&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Among the pulmonary parameters&#44; forced expiratory volume in 1 second &#40;FEV<span class="elsevierStyleInf">1</span>&#41; is the most important spirometric indicator of the severity of airflow obstruction&#46; However&#44; several studies have shown the weak relationship between FEV<span class="elsevierStyleInf">1</span> and mortality&#44;<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">9&#44;10</span></a> indeed&#44; it cannot be used to detect abnormal skeletal muscle function&#46; Recently&#44; the inspiratory capacity-to total lung capacity &#40;IC&#47;TLC&#41; ratio has emerged as a better marker of mortality and functional reserve and is associated with altered exercise capacity in COPD patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">11&#44;12</span></a> Recently&#44; Ramon et al&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">13</span></a> observed that the patients with COPD with lower IC&#47;TLC experience a higher longitudinal decline in exercise capacity&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">To date&#44; only one study has investigated the role of IC&#47;TLC ratio on the muscle function in the upper extremities in this population of patients&#46; Its authors found that maximal hand grip strength was lower among IC&#47;TLC<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>25&#37; than among patients with IC&#47;TLC<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>25&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">14</span></a> However&#44; no previous studies have established the correlation between the IC&#47;TLC ratio and lower extremity muscle mass&#44; maximal strength&#44; and muscle peak power output in this patient population&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Accordingly&#44; the primary aim of the present study was to determine whether the inspiratory capacity-to-total lung capacity ratio or inspiratory fraction would be useful in predicting skeletal muscle dysfunction in the lower and upper extremities&#46; We hypothesized that patients with IC&#47;TLC<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>25&#37; would have less maximal muscle strength of the lower and upper extremities and peak power output of the lower limbs than IC&#47;TLC<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>25&#37; patients&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Materials and methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Subjects</span><p id="par0025" class="elsevierStylePara elsevierViewall">Thirty-five men with stable COPD were recruited <span class="elsevierStyleItalic">via</span> an outpatient clinic through the local pulmonologist office to participate in the study&#46; All patients had received a clinical and functional diagnosis of COPD according to the GOLD criteria &#40;stages II and III&#41;&#46; Patients presented with moderate-to-severe airways obstruction &#40;FEV<span class="elsevierStyleInf">1</span>&#47;FVC<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;7 and FEV<span class="elsevierStyleInf">1</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>80&#37; but FEV<span class="elsevierStyleInf">1</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>30&#37; predicted&#41;&#46; Inclusion criteria include&#58; &#40;1&#41; dyspnea &#40;mMMRC grades II and III&#41;&#59; &#40;2&#41; ex-smokers status&#59; and &#40;3&#41; aged 60&#8211;80 yrs&#46; Exclusion criteria include&#58; &#40;1&#41; having never smoked&#59; &#40;2&#41; exacerbation of symptoms in the preceding three months&#59; and &#40;3&#41; cardiovascular&#44; neuromuscular&#44; musculoskeletal or arthritic problems that might limit exercise tolerance&#46; The patients were informed carefully about the procedures and possible risks of the experiments&#44; as well as the benefits of the project&#44; and written consent was obtained&#46; The Research Ethics Committees of the Public University of Navarre and Virgen del Camino Hospital approved the study&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Pulmonary functional and clinical assessments</span><p id="par0030" class="elsevierStylePara elsevierViewall">Baseline assessment included&#58; &#40;1&#41; spirometry&#44; lung volumes by body plethysmography&#44; maximal inspiratory and expiratory pressure according with recommended methods&#59; &#40;2&#41; anthropometric variables&#59; &#40;3&#41; 6-min&#44; walk test &#40;6MWT&#41;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">15</span></a>&#59; and &#40;4&#41; BODE index&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Thigh muscle mass</span><p id="par0035" class="elsevierStylePara elsevierViewall">Muscle mass &#40;MM&#41; of the thigh &#40;T&#41; were assessed using magnetic resonance imaging &#40;MRI&#59; 1&#46;5<span class="elsevierStyleHsp" style=""></span>T&#59; Siemens Magnetom&#44; Germany&#41;&#46; The length of the femur &#40;Lf&#41;&#44; taken as the distance from the intercondylar notch of the femur to the superior boundary of the femoral head was measured on a coronal plane&#46; Subsequently&#44; 15 axial scans of the thigh interspaced by a distance of 1&#47;15<span class="elsevierStyleHsp" style=""></span>Lf were obtained from 1&#47;15<span class="elsevierStyleHsp" style=""></span>Lf to 15&#47;15<span class="elsevierStyleHsp" style=""></span>Lf&#46; MR imaging of both thighs was obtained&#46; Cross-sectional volumes &#40;cm<span class="elsevierStyleSup">3</span>&#41; of the thigh at 30&#37; proximal&#44; 50&#37;&#44; and 70&#37; distal of the Lf were used for further analysis&#46; The total volume &#40;cm<span class="elsevierStyleSup">3</span>&#41; of the MM<span class="elsevierStyleInf">T</span> was calculated as the combination of the 30&#44; 50&#44; and 70&#37; of the Lf&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">16</span></a></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Physical activity</span><p id="par0040" class="elsevierStylePara elsevierViewall">Habitual physical activity was evaluated using accelerometry &#40;TriTrac-R3D system&#59; WI&#44; USA&#41;&#46; The TriTrac was worn around the waist&#46; TriTrac monitoring was recorded on a minute-by-minute basis during two weekdays and two weekend days&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Lower extremity maximal strength and muscle peak power output</span><p id="par0045" class="elsevierStylePara elsevierViewall">One repetition maximum &#40;the heaviest load that could be lifted only once using the correct technique&#41; was determined for the leg press exercise &#40;1RM<span class="elsevierStyleInf">LP</span>&#41; &#40;Technogym&#44; Gambettola&#44; Italy&#41;&#46; Three-to-four subsequent attempts were made to determine 1RM&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">16</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">The subjects were instructed to exert their maximal force as fast as possible&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Muscle peak power output of the leg extensor muscles was measured during the concentric phase of leg press using the load equal to 50 and 70&#37; of 1RM&#46; An optical encoder &#40;Computer Optical Products Inc&#46;&#44; CA&#44; USA&#41; was attached to weight plates to record the position and direction of the displacement to an accuracy of 0&#46;2<span class="elsevierStyleHsp" style=""></span>mm at 1000<span class="elsevierStyleHsp" style=""></span>Hz&#46; Subjects were instructed to displace the weights as fast as possible&#46; Two testing trials were recorded and the best trial was taken for further analysis&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Upper extremity maximal strength</span><p id="par0060" class="elsevierStylePara elsevierViewall">One repetition maximum &#40;1RM&#41; was determined for seated chest press &#40;1RM<span class="elsevierStyleInf">CP</span>&#41;&#44; shoulder press&#44; and seated row &#40;Technogym&#44; Gambettola&#44; Italy&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">16</span></a></p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Systemic inflammation</span><p id="par0065" class="elsevierStylePara elsevierViewall">After 10<span class="elsevierStyleHsp" style=""></span>h of fasting and 1 day of minimal physical activity&#44; venous blood samples were obtained at rest between 8 and 10<span class="elsevierStyleHsp" style=""></span>a&#46;m&#46; from the antecubital vein for the determination of interleukin-6 &#40;IL-6&#41;&#44; tumor necrosis factor &#945; &#40;TNF-&#945;&#41;&#44; C-reactive protein &#40;CRP&#41;&#44; and plasma vascular endothelial growth factor A &#40;VEGF-A&#41; concentrations&#46; Circulating concentrations of IL-6&#44; TNF-&#945;&#44; CRP&#44; and VEGF-A were assessed in duplicate using commercially available enzyme-linked immune absorbent assay and radioimmunoassay kits&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Statistical analysis</span><p id="par0070" class="elsevierStylePara elsevierViewall">Standard statistical methods were used to calculate mean and standard deviations &#40;SPSS&#44; Chicago&#44; Illinois&#41;&#46; Statistical treatment was performed using SPSS program version 23&#46;0&#46; The assumption of a normal distribution of the data was evaluated with a Shapiro&#8211;Wilk test&#46; Cross-sectional comparisons between groups were performed by either a parametric &#40;unpaired <span class="elsevierStyleItalic">t</span>-test&#41; or a non-parametric test &#40;Mann&#8211;Whitney <span class="elsevierStyleItalic">U</span> test&#41;&#46; Pearson product-moment or Rho Spearman correlation coefficients were used to determine the association between variables of interests&#46; Due to the small size of the sample&#44; the <span class="elsevierStyleItalic">p</span>-value was simulated using bootstrap method with replacement procedure as part of the analysis&#46; A random sample was designed with replacement from the original sample to produce a new sample of the same size as the original&#46; This procedure was repeated for each sample separately&#44; and the difference in mean calculated&#46; This procedure was repeated 1000 times&#46; The <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05 criterion was used to establish statistical significance&#46; Values are reported as mean values<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>standard deviations &#40;SD&#41;&#46;</p></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Results</span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Clinical characteristics and physical activity</span><p id="par0075" class="elsevierStylePara elsevierViewall">Clinical characteristics according to the IC&#47;TLC ratio are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; The 6MWT distance was lower &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#59; bootstrap <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; and the BODE index was higher &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#59; bootstrap <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; in the IC&#47;TLC<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>25&#37; group&#46; IL-6 and CRP concentrations were higher &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#59; bootstrap <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#41; in the IC&#47;TLC<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>25&#37; group&#46; Habitual physical activity during the four days was 23&#37; lower &#40;7228<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1459<span class="elsevierStyleHsp" style=""></span>kcal <span class="elsevierStyleItalic">vs</span>&#46; 9250<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1952<span class="elsevierStyleHsp" style=""></span>kcal&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#59; bootstrap <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; in the IC&#47;TLC<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>25&#37; group than in the IC&#47;TLC<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>25&#37; group&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Thigh muscle mass</span><p id="par0080" class="elsevierStylePara elsevierViewall">MM<span class="elsevierStyleInf">T</span> volume at 30&#37;&#44; 50&#37;&#44; and 70&#37; Lf were lower &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#59; bootstrap <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; in the IC&#47;TLC<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>25&#37; group than in the IC&#47;TLC<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>25&#37; group &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; Total MM<span class="elsevierStyleInf">T</span> volume was lower &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#59; bootstrap <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; in the IC&#47;TLC<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>25&#37; group &#40;413&#46;91<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>89&#46;42<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">3</span>&#41; than in the IC&#47;TLC<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>25&#37; group &#40;575&#46;20<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>115&#46;25<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">3</span>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Lower extremity maximal dynamic strength and muscle peak power output</span><p id="par0085" class="elsevierStylePara elsevierViewall">The 1RM<span class="elsevierStyleInf">LP</span> exercise was 36&#37; lower &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;00&#59; bootstrap <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; in the IC&#47;TLC<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>25&#37; group &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; Interestingly&#44; when maximal bilateral concentric strength were expressed relative to total MM<span class="elsevierStyleInf">T</span> volume&#44; the differences between the groups disappeared &#40;0&#46;36<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;06 <span class="elsevierStyleItalic">vs</span>&#46; 0&#46;35<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;08<span class="elsevierStyleHsp" style=""></span>kg<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">&#8722;3</span>&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;70&#59; bootstrap <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;73&#41; in the IC&#47;TLC<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>25&#37; and IC&#47;TLC<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>25&#37;&#44; respectively&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">Lower extremities muscle peak power output at 50 and 70&#37; of 1 RM was 43&#37; &#40;495<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>192 <span class="elsevierStyleItalic">vs</span>&#46; 711<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>216<span class="elsevierStyleHsp" style=""></span>W&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0&#59; bootstrap <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; and 56&#37; &#40;390<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>168 <span class="elsevierStyleItalic">vs</span>&#46; 612<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>211<span class="elsevierStyleHsp" style=""></span>W&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#59; bootstrap <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; lower in the IC&#47;TLC<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>25&#37; group&#44; respectively&#46; When muscle peak power output was expressed relative to kilogram of body mass&#44; the difference was reduced to 26&#37; at the load of 50&#37; &#40;6&#46;89<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;95 <span class="elsevierStyleItalic">vs</span>&#46; 8&#46;74<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;77<span class="elsevierStyleHsp" style=""></span>W<span class="elsevierStyleHsp" style=""></span>kg<span class="elsevierStyleSup">&#8722;1</span>&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;032&#59; bootstrap <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;014&#41; and 36&#37; at the load of 70&#37; &#40;5&#46;48<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;86 <span class="elsevierStyleItalic">vs</span>&#46; 7&#46;48<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;39<span class="elsevierStyleHsp" style=""></span>W<span class="elsevierStyleHsp" style=""></span>kg<span class="elsevierStyleSup">&#8722;1</span>&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#59; bootstrap <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;002&#41; in the IC&#47;TLC<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>25&#37; than in the IC&#47;TLC<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>25&#37; group&#44; respectively&#46; When muscle peak power output was expressed relative to total MM<span class="elsevierStyleInf">T</span> volume&#44; the differences between the groups were abolished at the load of 50&#37; of 1RM &#40;1&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;3 <span class="elsevierStyleItalic">vs</span>&#46; 1&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;3<span class="elsevierStyleHsp" style=""></span>W<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">&#8722;3</span>&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;35&#59; bootstrap <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;70&#41; in the IC&#47;TLC<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>25&#37; compared with the IC&#47;TLC<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>25&#37;&#44; respectively&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Upper extremity maximal dynamic strength</span><p id="par0095" class="elsevierStylePara elsevierViewall">The 1RM<span class="elsevierStyleInf">CP</span> was 42&#37; lower &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#59; bootstrap <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; in the IC&#47;TLC<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>25&#37; group &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; Maximal dynamic strength 1RM in the seated row and shoulder press was 25&#37; lower &#40;42&#46;03<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#46;5 <span class="elsevierStyleItalic">vs</span>&#46; 52&#46;63<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;2<span class="elsevierStyleHsp" style=""></span>kg&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#59; bootstrap <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; and 29&#37; lower &#40;47&#46;86<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#46;9 <span class="elsevierStyleItalic">vs</span>&#46; 62&#46;10<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>15&#46;6<span class="elsevierStyleHsp" style=""></span>kg&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;003&#59; bootstrap <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;002&#41; in the IC&#47;TLC<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>25&#37; group than in the IC&#47;TLC<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>25&#37; group&#44; respectively&#46;</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Associations</span><p id="par0100" class="elsevierStylePara elsevierViewall">The IC&#47;TLC ratio was positively associated with total MM<span class="elsevierStyleInf">T</span> volume &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#44; 1RM<span class="elsevierStyleInf">LP</span> &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;57&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#44; 1RM<span class="elsevierStyleInf">CP</span> &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;60&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; and physical activity &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;55&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; for the entire group&#46; The FEV<span class="elsevierStyleInf">1</span> &#40;&#37; predicted&#41; was positively associated with total MM<span class="elsevierStyleInf">T</span> volume &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;46&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#41;&#44; 1RM<span class="elsevierStyleInf">LP</span> &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;43&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#41;&#44; and physical activity &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;54&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; for the entire group&#46; Moreover&#44; physical activity was positively associated with total MM<span class="elsevierStyleInf">T</span> volume &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;81&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#44; 1RM<span class="elsevierStyleInf">LP</span> &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;62&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#44; and muscle power at 50&#37; 1RM &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;78&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46; In addition&#44; a negative linear relationship was found between IL-6 and MMT volume &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;40&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;02&#41;&#44; 1RM<span class="elsevierStyleInf">LP</span> &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;50&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#41; and muscle power at 50&#37; of 1RM &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;46&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#41; for the entire group&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Discussion</span><p id="par0105" class="elsevierStylePara elsevierViewall">The salient findings of this study were that thigh muscle mass&#44; lower and upper maximal strength&#44; and leg muscle peak power output was reduced significantly in COPD patients with IC&#47;TLC<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>25&#37;&#46; In addition&#44; the IC&#47;TLC a predictor of mortality&#44; was related to thigh muscle mass and the maximal strength of lower and upper extremities&#46; The present findings suggest that IC&#47;TLC<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>25&#37; may be valued as an applicable index of skeletal muscle dysfunction in chronic obstructive pulmonary disease patients&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">An inspiratory-to total lung capacity ratio of &#8804;25&#37; is an important independent predictor of increased mortality&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">11</span></a> Recently&#44; Ramon et al&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">13</span></a> observed that the patients with COPD with lower IC&#47;TLC experience a higher longitudinal decline in exercise capacity and IC&#47;TLC and dyspnea in clinically stable patients with COPD predict their exercise capacity&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">On the basis of previous studies suggesting that lower fat-free mass and reduced grip strength is related to an IC&#47;TLC of &#8804;25&#37;&#44;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">14</span></a> we sought to determine whether an IC&#47;TLC of &#8804;25&#37; would translate to unfavorable changes in muscle mass and muscle function &#40;maximal strength and power output normalized to muscle cross-sectional area&#41; in the lower extremities&#46; Skeletal muscle weakness in the lower extremities has previously been shown to be more established with the increase of the dyspnea&#44; BODE index score&#44; and disease severity in COPD patients&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">17</span></a> Previous studies have observed that reduced thigh muscle cross-sectional area<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">3</span></a> and reduced maximal quadriceps strength&#44;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">1</span></a> which result in an impaired functional capacity&#44;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">18</span></a> is related to increased mortality<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">19</span></a> and health care utilization&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">4</span></a> Recently&#44; it has been also reported that lower extremity muscle power remains as a more discriminating variable for understanding the relationships between impairments&#44; functional limitations&#44; and resultant disability with aging&#46;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">5&#44;6</span></a> However&#44; no previous study has determined that the IC&#47;TLC ratio is a marker of muscle atrophy and reduced maximal strength and muscle power output in the lower limbs in COPD patients&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">A unique findings in this present study was that thigh muscle mass and maximal dynamic strength in the lower limbs were lower in the IC&#47;TLC<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>25&#37; group&#46; This hypothesis was strengthened by the relationship observed between the IC&#47;TLC and muscle mass &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;67&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; and lower maximal strength &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;57&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#41;&#46; In this study&#44; we extended our investigation by determining the relationship between the IC&#47;TLC<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>25&#37; group and the maximal strength of the upper limbs&#46; Indeed&#44; reduced maximal strength in the upper extremities was found in the IC&#47;TLC<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>25&#37; group&#46; This suggests that the inspiratory-to-total lung capacity ratio of &#8804;25&#37; is a surrogate marker of thigh muscle atrophy and peripheral skeletal muscle weakness&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Recently&#44; impairments in muscle peak power output in the lower extremity have emerged as a more important predictor of limitations in mobility in tasks such as rising from a chair&#44; climbing stairs&#44; habitual walking speed&#44; and even the prevention of falls&#44; than maximal muscle strength in older adults&#46;<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">20&#8211;24</span></a> To the best of our knowledge&#44; this is the first study to report the association between the IC&#47;TLC ratio and lower extremity muscle peak power in patients with COPD&#46; Our results indicate that muscle peak power output at 50 and 70&#37; of 1RM is reduced in COPD patients with an IC&#47;TLC of &#8804;25&#37;&#46; Furthermore&#44; a slowed-down capacity for muscle power output and delayed responsiveness to accidental falls in the lower and upper limbs is associated with disability&#46;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">5&#44;6</span></a> It has been documented that in older adults<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">25</span></a> with lower extremity power at high velocities &#40;40&#37; 1RM&#41; contractions were a better predictor of habitual gait velocity than power at low velocities &#40;70&#37; 1RM&#41;&#46; One of the major findings in this study was that when maximal bilateral dynamic strength and muscle power output were expressed relative to total MM<span class="elsevierStyleInf">T</span>&#44; the differences between the groups disappeared&#46; This suggests that the impairment in peripheral muscle function of the lower limbs in patients with IC&#47;TLC<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>25&#37; is mainly due to loss of muscle mass and that neural activation patterns and&#47;or twitch tension per muscle mass volume under maximal concentric actions &#40;typical leg extension actions also in normal daily activities&#41; could be rather similar between groups&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">It is no clear which physiological mechanisms explained the reductions in muscle mass in COPD patients with an IC&#47;TLC of &#8804;25&#37;&#46; In healthy older adults&#44; reduced maximal strength has been attributed to a great extent to the reduction in muscle mass&#44; which is perhaps related to alterations in hormone balance<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">26</span></a> and the decline in the quantity and intensity of physical activity&#46;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">27</span></a> In this context&#44; we postulated that lower limb muscle mass and reductions in maximal strength and peak power output might be due to elevated inflammation and the physical inactivity associated with the systemic inflammation&#46;<a class="elsevierStyleCrossRefs" href="#bib0300"><span class="elsevierStyleSup">28&#44;29</span></a> Consistent with the first part of the hypothesis&#44; we found that patients with an IC&#47;TLC of &#8804;25&#37; have elevated CRP and IL-6 levels and also&#44; we observed a negative relationship between IL-6 and muscle mass&#44; lower extremity maximal dynamic strength and leg muscle peak power output&#46; Therefore&#44; the present results might indicate that the effects of circulating IL-6 may be associated with reduced muscle mass and skeletal muscle weakness&#46; The results contradict the findings of Pleguezuelos et al&#46;<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">30</span></a> who did not observe any significant relationship between quadriceps strength and IL-6&#46; These differences might occur because of the maximum strength measurement &#40;<span class="elsevierStyleItalic">i&#46;e&#46;</span>&#44; dynamic maximum test <span class="elsevierStyleItalic">vs&#46;</span> isokinetic test&#41;&#46; Previous studies have shown that higher levels of systemic inflammation are associated with reduced physical activity in patients with COPD&#44;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">7</span></a> and the older adults who are physically inactive have higher levels of systemic inflammatory markers than those who are physically active&#46;<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">31</span></a> In support of the second part&#44; the IC&#47;TLC<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>25&#37; group demonstrated a 23&#37; lower habitual physical activity&#46; Moreover&#44; physical activity was positively associated with lower extremity maximal strength&#44; muscle power output&#44; and thigh muscle mass in the pooled group&#46; In the present study&#44; IC&#47;TLC ratio was positively associated with physical activity &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;55&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; for the entire group&#44; suggesting that those patients with higher static hyperinflation &#40;low IC&#47;TLC&#41; are less physically active&#46; A limitation of our study is that there was no direct dynamic hyperinflation during the 6MWT measurements&#46; Garcia-Rio et al&#46;<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">32</span></a> have reported that the reduced daily physical activity of patients with moderate-severe COPD might be partially explained by the development of dynamic hyperinflation&#44; regardless of the severity of the disease&#46; Garcia-Rio et al&#46;<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">32</span></a> have showed that the increase in EELV during exercise was associated with dyspnea as evaluated by the MRC scale&#46; This breathlessness could promote the limitation when the patients performed their daily physical activity&#44; increasing the physical inactivity&#46; At the same time&#44; this physical inactivity could contribute to the weakness and atrophy of the muscles&#44; leading to a vicious circle that causes more physical inactivity&#44; atrophy and skeletal muscle dysfunction&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">There are several methodological limitations in our experimental approach&#46; First&#44; as the size of the sample in the study was small&#44; we used the bootstrapping procedure as part of the statistical analysis&#44; strengthening our results&#46; Second&#44; we did not take into account patients who received corticosteroids&#46; Previous studies<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">1</span></a> have shown that quadriceps strengthened but thigh muscle mass was lower in those patients who received systemic corticosteroids&#46; However&#44; the patients in our study received the same medical treatment and exacerbation was an exclusion criteria&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">In conclusion&#44; the results of this study indicate that the inspiratory-to total lung capacity ratio may be an effective pulmonary measurement to determine muscle atrophy in the lower extremities and skeletal muscle dysfunction&#46; The relationship observed is clinically important because an IC&#47;TLC of &#8804;25&#37; can be used as an index to detect skeletal muscle weakness&#46;</p></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Ethical responsibilities</span><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Protection of human and animal subjects</span><p id="par0145" class="elsevierStylePara elsevierViewall">The authors declare that the procedures followed were in accordance with the regulations of the relevant clinical research ethics committee and with those of the Code of Ethics of the World Medical Association &#40;Declaration of Helsinki&#41;&#46;</p></span><span id="sec0100" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Confidentiality of data</span><p id="par0150" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their work center on the publication of patient data&#46;</p></span><span id="sec0105" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Right to privacy and informed consent</span><p id="par0155" class="elsevierStylePara elsevierViewall">The authors have obtained the written informed consent of the patients or subjects mentioned in the article&#46;</p></span></span><span id="sec0110" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Conflicts of interest</span><p id="par0160" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:10 [
        0 => array:3 [
          "identificador" => "xres792797"
          "titulo" => "Abstract"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "abst0005"
              "titulo" => "Background"
            ]
            1 => array:2 [
              "identificador" => "abst0010"
              "titulo" => "Methods"
            ]
            2 => array:2 [
              "identificador" => "abst0015"
              "titulo" => "Results"
            ]
            3 => array:2 [
              "identificador" => "abst0020"
              "titulo" => "Conclusion"
            ]
          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec791286"
          "titulo" => "Keywords"
        ]
        2 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        3 => array:3 [
          "identificador" => "sec0010"
          "titulo" => "Materials and methods"
          "secciones" => array:8 [
            0 => array:2 [
              "identificador" => "sec0015"
              "titulo" => "Subjects"
            ]
            1 => array:2 [
              "identificador" => "sec0020"
              "titulo" => "Pulmonary functional and clinical assessments"
            ]
            2 => array:2 [
              "identificador" => "sec0025"
              "titulo" => "Thigh muscle mass"
            ]
            3 => array:2 [
              "identificador" => "sec0030"
              "titulo" => "Physical activity"
            ]
            4 => array:2 [
              "identificador" => "sec0035"
              "titulo" => "Lower extremity maximal strength and muscle peak power output"
            ]
            5 => array:2 [
              "identificador" => "sec0040"
              "titulo" => "Upper extremity maximal strength"
            ]
            6 => array:2 [
              "identificador" => "sec0045"
              "titulo" => "Systemic inflammation"
            ]
            7 => array:2 [
              "identificador" => "sec0050"
              "titulo" => "Statistical analysis"
            ]
          ]
        ]
        4 => array:3 [
          "identificador" => "sec0055"
          "titulo" => "Results"
          "secciones" => array:5 [
            0 => array:2 [
              "identificador" => "sec0060"
              "titulo" => "Clinical characteristics and physical activity"
            ]
            1 => array:2 [
              "identificador" => "sec0065"
              "titulo" => "Thigh muscle mass"
            ]
            2 => array:2 [
              "identificador" => "sec0070"
              "titulo" => "Lower extremity maximal dynamic strength and muscle peak power output"
            ]
            3 => array:2 [
              "identificador" => "sec0075"
              "titulo" => "Upper extremity maximal dynamic strength"
            ]
            4 => array:2 [
              "identificador" => "sec0080"
              "titulo" => "Associations"
            ]
          ]
        ]
        5 => array:2 [
          "identificador" => "sec0085"
          "titulo" => "Discussion"
        ]
        6 => array:3 [
          "identificador" => "sec0090"
          "titulo" => "Ethical responsibilities"
          "secciones" => array:3 [
            0 => array:2 [
              "identificador" => "sec0095"
              "titulo" => "Protection of human and animal subjects"
            ]
            1 => array:2 [
              "identificador" => "sec0100"
              "titulo" => "Confidentiality of data"
            ]
            2 => array:2 [
              "identificador" => "sec0105"
              "titulo" => "Right to privacy and informed consent"
            ]
          ]
        ]
        7 => array:2 [
          "identificador" => "sec0110"
          "titulo" => "Conflicts of interest"
        ]
        8 => array:2 [
          "identificador" => "xack265527"
          "titulo" => "Acknowledgments"
        ]
        9 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2016-04-18"
    "fechaAceptado" => "2016-07-21"
    "PalabrasClave" => array:1 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec791286"
          "palabras" => array:6 [
            0 => "Chronic obstructive pulmonary disease"
            1 => "Inspiratory fraction"
            2 => "Muscle mass"
            3 => "Muscle strength"
            4 => "Limb muscle dysfunction"
            5 => "Muscle power"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:1 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">An inspiratory capacity to total lung capacity &#40;IC&#47;TLC&#41; ratio of &#8804;25&#37; has emerged as a better marker of mortality in chronic obstructive pulmonary disease &#40;COPD&#41; patients&#46; The relationship among the IC&#47;TLC ratio to lower extremity skeletal muscle function remains unknown&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Thirty-five men with moderate to severe COPD were divided into those with IC&#47;TLC<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>25&#37; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>16&#41; and &#62;25&#37; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>19&#41;&#46; The subjects were tested for thigh muscle mass volume &#40;MMT&#41;&#44; maximal strength&#44; power output of the lower extremities&#44; and physical activity&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Total MMT in the IC&#47;TLC<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>25&#37; group was significantly lower &#40;413&#46;91<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>89&#46;42<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">3</span>&#41; &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; than in the IC&#47;TLC<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>25&#37; group &#40;575&#46;20<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#46;76<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">3</span>&#41;&#46; In the IC&#47;TLC<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>25&#37; group&#44; maximal strength of the lower extremities and muscle peak power output of the lower extremities were 36&#8211;56&#37; lower &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#41; than among the patients in the IC&#47;TLC<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>25&#37; group&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">IC&#47;TLC<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>25&#37; is associated with reduced maximal strength and peak power output of the lower extremities&#46; IC&#47;TLC<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>25&#37; may have an important clinical relevance as an index to determine peripheral muscle dysfunction&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Background"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Methods"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusion"
          ]
        ]
      ]
    ]
    "multimedia" => array:4 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1179
            "Ancho" => 1613
            "Tamanyo" => 77011
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Thigh muscle mass &#40;MM<span class="elsevierStyleInf">T</span>&#41; at 30&#37;&#44; 50&#37;&#44; and 70&#37; Lf according to IC&#47;TLC ratio&#46; Data are presented as means<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD&#46; &#42;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>0&#46;001 IC&#47;TLC<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>25&#37; <span class="elsevierStyleItalic">vs&#46;</span> IC&#47;TLC<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>25&#37;&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 1200
            "Ancho" => 1623
            "Tamanyo" => 68341
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Lower and upper body muscle maximal dynamic strength&#46; Maximal bilateral concentric 1RM in leg press and seated chest press in IC&#47;TLC<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>25&#37; and IC&#47;TLC<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>25&#37; group&#46; Data are presented as means<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD&#46; &#42;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001 IC&#47;TLC<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>25&#37; <span class="elsevierStyleItalic">vs&#46;</span> IC&#47;TLC<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>25&#37;&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "fig0015"
        "etiqueta" => "Figure 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr3.jpeg"
            "Alto" => 1221
            "Ancho" => 1610
            "Tamanyo" => 80095
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Relationship between IC&#47;TLC ratio and total MM<span class="elsevierStyleInf">T</span> in patients with IC&#47;TLC<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>25&#37; &#40;&#9633;&#41; and IC&#47;TLC<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>25&#37; &#40;&#9632;&#41;&#46;</p>"
        ]
      ]
      3 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Values expressed in mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD&#46; BMI<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>body mass index&#59; FEV<span class="elsevierStyleInf">1</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>forced expiratory volume in one second&#59; FVC<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>forced vital capacity&#59; TLC<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>total lung capacity&#59; RV<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>residual volume&#59; IC<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>inspiratory capacity&#59; <span class="elsevierStyleItalic">P</span>I&#44;max<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>maximal inspiratory pressure&#59; <span class="elsevierStyleItalic">P</span>E&#44;max<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>maximal expiratory pressure&#59; SpO<span class="elsevierStyleInf">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>arterial oxygen saturation measured by pulse oximetry&#59; Change SpO<span class="elsevierStyleInf">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>SpO<span class="elsevierStyleInf">2</span> before minus SpO<span class="elsevierStyleInf">2</span> at the end of 6MWT&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <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="" valign="top" scope="col" style="border-bottom: 2px solid black">&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">IC&#47;TLC<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>25&#37;&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">IC&#47;TLC<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>25&#37;&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>-Value&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">Bootstrap<br><span class="elsevierStyleItalic">p</span>-Value&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-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Subjects&#44; <span class="elsevierStyleItalic">n</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age&#44; y&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">71<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">68<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Body mass&#44; kg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">70&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">83&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>18&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;03&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Height&#44; cm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">166<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">167<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;70&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;76&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">BMI&#44; kg<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">&#8722;2</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">29&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">FEV<span class="elsevierStyleInf">1</span>&#44; &#37; predicted&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">37&#46;67<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#46;92&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">48&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#46;03&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;002&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">FVC&#44; &#37; predicted&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">67&#46;02<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>14&#46;14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">77&#46;69<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&#46;39&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;06&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">FEV<span class="elsevierStyleInf">1</span>&#47;FVC&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">41<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">45<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">TLC&#44; &#37; predicted&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">120&#46;09<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>21&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">115&#46;53<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>18&#46;13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;52&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">RV&#44; &#37; predicted&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">177&#46;69<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>41&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">153&#46;24<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;75&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;07&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;06&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">RV&#47;TLC&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">61&#46;95<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#46;36&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">52&#46;21<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#46;98&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">IC&#44; L&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;54<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;52<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;03&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">IC&#47;TLC&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;96&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">35&#46;47<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#46;57&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">P</span>I&#44;max&#44; cmH<span class="elsevierStyleInf">2</span>0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">69&#46;38<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">89&#46;16<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>25&#46;67&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;02&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">P</span>E&#44;max&#44; cmH<span class="elsevierStyleInf">2</span>0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">89&#46;81<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>37&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">101&#46;11<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>28&#46;57&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">6MWT&#44; m&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">409<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>108&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">528<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>74&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Final Borg dyspnea in the 6MWT&#44; score&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;34<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;11<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;84&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;76&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;76&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Final SpO<span class="elsevierStyleInf">2</span> in the 6MWT &#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">82<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#46;54&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">83<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;68&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;70&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Change SpO<span class="elsevierStyleInf">2</span> in 6MWT&#44; points&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#46;87<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#46;24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#46;88<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;69&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;68&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">BODE index&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">IL-6&#44; &#961;g<span class="elsevierStyleHsp" style=""></span>mL<span class="elsevierStyleSup">&#8722;1</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14&#46;42<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>17&#46;14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;86<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">VEGF-A&#44; &#961;g<span class="elsevierStyleHsp" style=""></span>mL<span class="elsevierStyleSup">&#8722;1</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">168&#46;21<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>295&#46;09&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">82&#46;36<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>70&#46;36&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">TNF-&#945;&#44; &#961;g<span class="elsevierStyleHsp" style=""></span>mL<span class="elsevierStyleSup">&#8722;1</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&#46;38<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#46;83&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&#46;98<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;07&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;54&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;53&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">CRP&#44; mg<span class="elsevierStyleHsp" style=""></span>dL<span class="elsevierStyleSup">&#8722;1</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;33<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;47&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;59<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;64&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1325778.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Clinical&#44; anthropometric characteristics and inflammatory markers in patients with chronic obstructive pulmonary disease according to inspiratory capacity to total lung capacity ratio&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:32 [
            0 => array:3 [
              "identificador" => "bib0165"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Peripheral muscle weakness in patients with chronic obstructive pulmonary disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46; Bernard"
                            1 => "P&#46; Leblanc"
                            2 => "F&#46; Whittom"
                            3 => "G&#46; Carrier"
                            4 => "J&#46; Jobin"
                            5 => "R&#46; Belleau"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/ajrccm.158.2.9711023"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "1998"
                        "volumen" => "158"
                        "paginaInicial" => "629"
                        "paginaFinal" => "634"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9700144"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0170"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Myopathological features in skeletal muscle of patients with chronic obstructive pulmonary disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "H&#46;R&#46; Gosker"
                            1 => "B&#46; Kubat"
                            2 => "G&#46; Schaart"
                            3 => "G&#46;J&#46; Van der Vusse"
                            4 => "E&#46;F&#46; Wouters"
                            5 => "A&#46;M&#46; Schols"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Respir J"
                        "fecha" => "2003"
                        "volumen" => "22"
                        "paginaInicial" => "280"
                        "paginaFinal" => "285"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12952261"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0175"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Midthigh muscle cross-sectional area is better predictor of mortality than body mass index in patients with chronic obstructive pulmonary disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "K&#46; Marquis"
                            1 => "R&#46; Debigar&#233;"
                            2 => "Y&#46; Lacasse"
                            3 => "P&#46; LeBlanc"
                            4 => "J&#46; Jobin"
                            5 => "G&#46; Carrier"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/rccm.2107031"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "2002"
                        "volumen" => "166"
                        "paginaInicial" => "809"
                        "paginaFinal" => "813"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12231489"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0180"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Muscle weakness is related to utilization of health care resources in COPD patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "M&#46; Decramer"
                            1 => "R&#46; Gosselink"
                            2 => "T&#46; Troosters"
                            3 => "M&#46; Verschueren"
                            4 => "G&#46; Evers"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Respir J"
                        "fecha" => "1997"
                        "volumen" => "10"
                        "paginaInicial" => "417"
                        "paginaFinal" => "423"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9042643"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0185"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Skeletal muscle power and functioning in older adults"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "K&#46;F&#46; Reid"
                            1 => "R&#46;A&#46; Fielding"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Exerc Sport Sci Rev"
                        "fecha" => "2012"
                        "volumen" => "40"
                        "paginaInicial" => "1"
                        "paginaFinal" => "12"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0190"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "How to simultaneously optimize muscle strength&#44; power&#44; functional capacity&#44; and cardiovascular gains in the elderly&#58; an update"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "E&#46;L&#46; Cadore"
                            1 => "M&#46; Izquierdo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s11357-012-9503-x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Age"
                        "fecha" => "2013"
                        "volumen" => "35"
                        "paginaInicial" => "2329"
                        "paginaFinal" => "2344"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23288690"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0195"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Extrapulmonary effects of chronic obstructive pulmonary disease on physical activity&#58; a cross-sectional study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "H&#46; Watz"
                            1 => "B&#46; Waschki"
                            2 => "C&#46; Boeheme"
                            3 => "M&#46; Claussen"
                            4 => "T&#46; Meyer"
                            5 => "H&#46; Magnussen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/rccm.200707-1011OC"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "2008"
                        "volumen" => "177"
                        "paginaInicial" => "743"
                        "paginaFinal" => "751"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18048807"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0200"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Characteristic of physical activity in daily life in chronic obstructive pulmonary disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "F&#46; Pitta"
                            1 => "T&#46; Troosters"
                            2 => "M&#46;A&#46; Spruit"
                            3 => "V&#46;S&#46; Probst"
                            4 => "M&#46; Decramer"
                            5 => "R&#46; Gosselink"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/rccm.200407-855OC"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "2005"
                        "volumen" => "171"
                        "paginaInicial" => "972"
                        "paginaFinal" => "977"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15665324"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0205"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pulmonary function is a long-term predictor of mortality in the general population&#58; 29-year follow-up of the Buffalo Health Study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "H&#46;J&#46; Sch&#252;nemann"
                            1 => "J&#46; Dorn"
                            2 => "B&#46;J&#46; Grant"
                            3 => "W&#46; Winkelstein Jr&#46;"
                            4 => "M&#46; Trevisan"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Chest"
                        "fecha" => "2000"
                        "volumen" => "118"
                        "paginaInicial" => "656"
                        "paginaFinal" => "664"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10988186"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0210"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Predictors of mortality in COPD"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "B&#46;R&#46; Celli"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.rmed.2009.12.017"
                      "Revista" => array:6 [
                        "tituloSerie" => "Respir Med"
                        "fecha" => "2010"
                        "volumen" => "104"
                        "paginaInicial" => "773"
                        "paginaFinal" => "779"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20417082"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0215"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Inspiratory-to-total lung capacity ratio predicts mortality in patients with chronic obstructive pulmonary disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "C&#46; Casanova"
                            1 => "C&#46; Cote"
                            2 => "J&#46;P&#46; de Torres"
                            3 => "A&#46; Aguirre-Jaime"
                            4 => "J&#46;M&#46; Marin"
                            5 => "V&#46; Pinto-Plata"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/rccm.200407-867OC"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "2005"
                        "volumen" => "171"
                        "paginaInicial" => "591"
                        "paginaFinal" => "597"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15591470"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0220"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Inspiratory fraction and exercise impairment in COPD patients GOLD stages II&#8211;III"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46;L&#46;P&#46; Alburquerque"
                            1 => "L&#46;E&#46; Nery"
                            2 => "D&#46;S&#46; Villa&#231;a"
                            3 => "T&#46;Y&#46; Machado"
                            4 => "C&#46;C&#46; Oliveira"
                            5 => "A&#46;T&#46; Paes"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1183/09031936.06.00040506"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Respir J"
                        "fecha" => "2006"
                        "volumen" => "28"
                        "paginaInicial" => "939"
                        "paginaFinal" => "944"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16870665"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0225"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Inspiratory capacity-to-total lung capacity ratio and dyspnoea predict exercise capacity decline in COPD"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46;A&#46; Ramon"
                            1 => "J&#46; Ferrer"
                            2 => "E&#46; Gimeno-Santos"
                            3 => "D&#46; Donaire-Gonzalez"
                            4 => "E&#46; Rodr&#237;guez"
                            5 => "E&#46; Balcells"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/resp.12723"
                      "Revista" => array:6 [
                        "tituloSerie" => "Respirology"
                        "fecha" => "2016"
                        "volumen" => "21"
                        "paginaInicial" => "476"
                        "paginaFinal" => "482"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26714424"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0230"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effects of hyperinflation on the oxygen pulse as a marker of cardiac performance in COPD"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "C&#46; Vassaux"
                            1 => "L&#46; Torre-Bouscoulet"
                            2 => "Z&#46; Zeineldine"
                            3 => "F&#46; Cortopassi"
                            4 => "H&#46; Paz-D&#237;az"
                            5 => "B&#46;R&#46; Celli"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1183/09031936.00151707"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Respir J"
                        "fecha" => "2008"
                        "volumen" => "32"
                        "paginaInicial" => "1275"
                        "paginaFinal" => "1282"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18550609"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0235"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "ATS statement&#58; guidelines for the six-minute walk test"
                      "autores" => array:1 [
                        0 => array:2 [
                          "colaboracion" => "ATS"
                          "etal" => false
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/ajrccm.166.1.at1102"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "2002"
                        "volumen" => "166"
                        "paginaInicial" => "111"
                        "paginaFinal" => "117"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12091180"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0240"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effects of strength training on muscle fatigue mapping from surface EMG and blood metabolites"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Izquierdo"
                            1 => "M&#46; Gonz&#225;lez-Izal"
                            2 => "I&#46; Navarro-Amezqueta"
                            3 => "J&#46;A&#46; Calbet"
                            4 => "J&#46; Iba&#241;ez"
                            5 => "A&#46; Malanda"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1249/MSS.0b013e3181edfa96"
                      "Revista" => array:6 [
                        "tituloSerie" => "Med Sci Sports Exerc"
                        "fecha" => "2011"
                        "volumen" => "43"
                        "paginaInicial" => "303"
                        "paginaFinal" => "311"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20581711"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0245"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The prevalence of quadriceps weakness in COPD and the relationship with disease severity"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;M&#46; Seymour"
                            1 => "M&#46;A&#46; Spruit"
                            2 => "N&#46;S&#46; Hopkinson"
                            3 => "S&#46;A&#46; Natanek"
                            4 => "W&#46;D&#46; Man"
                            5 => "A&#46; Jackson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1183/09031936.00104909"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Respir J"
                        "fecha" => "2010"
                        "volumen" => "36"
                        "paginaInicial" => "81"
                        "paginaFinal" => "88"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19897554"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0250"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Peripheral muscle weakness contributes to exercise limitation in COPD"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "R&#46; Gosselink"
                            1 => "T&#46; Troosters"
                            2 => "M&#46; Decramer"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/ajrccm.153.3.8630582"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "1996"
                        "volumen" => "153"
                        "paginaInicial" => "976"
                        "paginaFinal" => "980"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8630582"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0255"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Quadriceps strength predicts mortality in patients with moderate to severe chronic obstructive pulmonary disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "E&#46;B&#46; Swallow"
                            1 => "D&#46; Reyes"
                            2 => "N&#46;S&#46; Hopkinson"
                            3 => "W&#46;D&#46; Man"
                            4 => "R&#46; Porcher"
                            5 => "E&#46;J&#46; Cetti"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/thx.2006.062026"
                      "Revista" => array:6 [
                        "tituloSerie" => "Thorax"
                        "fecha" => "2007"
                        "volumen" => "62"
                        "paginaInicial" => "115"
                        "paginaFinal" => "120"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17090575"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0260"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Maximal and explosive force production capacity and balance performance in men of different ages"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "M&#46; Izquierdo"
                            1 => "X&#46; Aguado"
                            2 => "R&#46; Gonzalez"
                            3 => "J&#46;L&#46; L&#243;pez"
                            4 => "K&#46; H&#228;kkinen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Eur J Appl Physiol"
                        "fecha" => "1999"
                        "volumen" => "79"
                        "paginaInicial" => "260"
                        "paginaFinal" => "267"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0265"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Maximal strength and power characteristics in isometric and dynamic actions of the upper and lower extremities in middle-aged and older men"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Izquierdo"
                            1 => "J&#46; Iba&#241;ez"
                            2 => "E&#46; Gorostiaga"
                            3 => "M&#46; Garrues"
                            4 => "A&#46; Zu&#241;iga"
                            5 => "A&#46; Ant&#243;n"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1046/j.1365-201x.1999.00590.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Acta Physiol Scand"
                        "fecha" => "1999"
                        "volumen" => "167"
                        "paginaInicial" => "57"
                        "paginaFinal" => "58"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10519978"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0270"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Leg extensor power and functional performance in very old men and women"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "E&#46;J&#46; Bassey"
                            1 => "M&#46;A&#46; Fiatarone"
                            2 => "E&#46;F&#46; O&#8217;Neill"
                            3 => "M&#46; Kelly"
                            4 => "W&#46;J&#46; Evans"
                            5 => "L&#46;A&#46; Lipsitz"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Sci"
                        "fecha" => "1992"
                        "volumen" => "82"
                        "paginaInicial" => "321"
                        "paginaFinal" => "327"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1312417"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0275"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A comparison of leg power and leg strength within the InCHIANTI study&#58; which influences mobility more&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "J&#46;F&#46; Bean"
                            1 => "S&#46;G&#46; Leveille"
                            2 => "D&#46;K&#46; Kiely"
                            3 => "S&#46; Bandinelli"
                            4 => "J&#46;M&#46; Guralnik"
                            5 => "L&#46; Ferruci"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Gerontol A Biol Sci Med Sci"
                        "fecha" => "2003"
                        "volumen" => "58"
                        "paginaInicial" => "728"
                        "paginaFinal" => "733"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12902531"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib0280"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effect of high versus low-velocity resistance training on muscular fitness and functional performance in older men"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "M&#46; Bottaro"
                            1 => "S&#46;N&#46; Machado"
                            2 => "W&#46; Nogueira"
                            3 => "R&#46; Scales"
                            4 => "J&#46; Veloso"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00421-006-0343-1"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Appl Physiol"
                        "fecha" => "2007"
                        "volumen" => "99"
                        "paginaInicial" => "257"
                        "paginaFinal" => "264"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17146693"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib0285"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Impact of muscle power and force on gait speed in disabled older men and women"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "A&#46; Cuoco"
                            1 => "D&#46;M&#46; Callahan"
                            2 => "S&#46; Sayers"
                            3 => "W&#46;R&#46; Frontera"
                            4 => "J&#46; Bean"
                            5 => "R&#46;A&#46; Fielding"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Gerontol A Biol Sci Med Sci"
                        "fecha" => "2004"
                        "volumen" => "59"
                        "paginaInicial" => "1200"
                        "paginaFinal" => "1206"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15602076"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib0290"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Serum hormones and strength development during strength training in middle-aged and elderly males and females"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "K&#46; H&#228;kkinen"
                            1 => "A&#46; Pakarinen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1748-1716.1994.tb09678.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Acta Physiol Scand"
                        "fecha" => "1994"
                        "volumen" => "150"
                        "paginaInicial" => "211"
                        "paginaFinal" => "219"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8191900"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib0295"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The physical activity of healthy and chronically ill adults in Finland at work&#44; at leisure and during commuting"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "E&#46; M&#228;lki&#228;"
                            1 => "O&#46; Impivaara"
                            2 => "M&#46; Heli&#246;vaara"
                            3 => "J&#46; Maatela"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Scand J Med Sci Sports"
                        "fecha" => "1994"
                        "volumen" => "4"
                        "paginaInicial" => "82"
                        "paginaFinal" => "87"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib0300"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Systemic effects of chronic obstructive pulmonary disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "A&#46;G&#46;N&#46; Agusti"
                            1 => "A&#46; Noguera"
                            2 => "J&#46; Sauleda"
                            3 => "E&#46; Sala"
                            4 => "J&#46; Pons"
                            5 => "X&#46; Busquests"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Respir J"
                        "fecha" => "2003"
                        "volumen" => "21"
                        "paginaInicial" => "347"
                        "paginaFinal" => "360"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12608452"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib0305"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Skeletal muscle weakness&#44; reduced exercise tolerance&#44; and COPD&#58; is systemic inflammation the missing link"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "D&#46;D&#46; Sin"
                            1 => "S&#46;F&#46; Man"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/thx.2005.044941"
                      "Revista" => array:6 [
                        "tituloSerie" => "Thorax"
                        "fecha" => "2006"
                        "volumen" => "61"
                        "paginaInicial" => "1"
                        "paginaFinal" => "3"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16396949"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib0310"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Muscular dysfunction in COPD&#58; Systemic effect or deconditioning"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "E&#46; Pleguezuelos"
                            1 => "C&#46; Esquinas"
                            2 => "E&#46; Moreno"
                            3 => "L&#46; Guirao"
                            4 => "J&#46; Ortiz"
                            5 => "J&#46; Garcia-Alsina"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00408-015-9838-z"
                      "Revista" => array:6 [
                        "tituloSerie" => "Lung"
                        "fecha" => "2016"
                        "volumen" => "194"
                        "paginaInicial" => "249"
                        "paginaFinal" => "257"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26743191"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            30 => array:3 [
              "identificador" => "bib0315"
              "etiqueta" => "31"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Physical activity and hemostatic and inflammatory variables in elderly men"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "S&#46;G&#46; Wannamethee"
                            1 => "G&#46;D&#46; Lowe"
                            2 => "P&#46;H&#46; Whincup"
                            3 => "A&#46; Rumley"
                            4 => "M&#46; Walker"
                            5 => "L&#46; Lennon"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Circulation"
                        "fecha" => "2002"
                        "volumen" => "105"
                        "paginaInicial" => "1785"
                        "paginaFinal" => "1790"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11956120"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            31 => array:3 [
              "identificador" => "bib0320"
              "etiqueta" => "32"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Daily physical activity in patients with chronic obstructive pulmonary disease is mainly associated with dynamic hyperinflation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "F&#46; Garcia-Rio"
                            1 => "V&#46; Lores"
                            2 => "O&#46; Mediano"
                            3 => "B&#46; Rojo"
                            4 => "A&#46; Hernanz"
                            5 => "E&#46; L&#243;pez-Collazo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/rccm.200812-1873OC"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "2009"
                        "volumen" => "180"
                        "paginaInicial" => "506"
                        "paginaFinal" => "512"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19542481"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
    "agradecimientos" => array:1 [
      0 => array:4 [
        "identificador" => "xack265527"
        "titulo" => "Acknowledgments"
        "texto" => "<p id="par0165" class="elsevierStylePara elsevierViewall">This study was conducted with the support of the <span class="elsevierStyleGrantSponsor" id="gs1">Spanish Ministry of Education and Science</span> &#40;Plan Nacional I<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>D<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>i 2004-2007 y 2008-20011 Strategic action&#58; &#8220;Sport and physical education&#8221; Ref&#58; <span class="elsevierStyleGrantNumber" refid="gs1">DEP2007-73220</span>&#44; <span class="elsevierStyleGrantNumber" refid="gs1">DEP2011-30042</span>&#41; and <span class="elsevierStyleGrantSponsor" id="gs2">Health Sciences Department of Government of Navarre</span>&#46;</p>"
        "vista" => "all"
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/21735115/0000002300000001/v1_201701210027/S2173511516300896/v1_201701210027/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "9710"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Original articles"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/21735115/0000002300000001/v1_201701210027/S2173511516300896/v1_201701210027/en/main.pdf?idApp=UINPBA00004E&text.app=https://journalpulmonology.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173511516300896?idApp=UINPBA00004E"
]
Article information
ISSN: 21735115
Original language: English
The statistics are updated each day
Year/Month Html Pdf Total
2024 November 9 8 17
2024 October 22 39 61
2024 September 20 27 47
2024 August 46 34 80
2024 July 38 34 72
2024 June 49 19 68
2024 May 30 36 66
2024 April 20 24 44
2024 March 34 23 57
2024 February 21 34 55
2024 January 17 25 42
2023 December 16 18 34
2023 November 22 44 66
2023 October 19 43 62
2023 September 21 31 52
2023 August 7 13 20
2023 July 17 27 44
2023 June 17 18 35
2023 May 23 29 52
2023 April 13 14 27
Show all

Follow this link to access the full text of the article

Pulmonology

Are you a health professional able to prescribe or dispense drugs?