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INVESTIGATION OF THE RELATIONSHIP OF MUSCLE STRENGTH AND BODY COMPOSITION WITH FUNCTIONAL CAPACITY, PHYSICAL PERFORMANCE AND HEALTH-RELATED QUALITY OF LIFE IN PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE: A RETROSPECTIVE STUDY

Year 2023, , 403 - 410, 04.12.2023
https://doi.org/10.34108/eujhs.1284636

Abstract

Aim of this study was to examine the relation ship of musclestrength and body composition with functional capacity, dyspneas everity, co-morbidities, physical performance and health-related quality of life (HRQoL) in patients with chronic obstructive pulmonary disease (COPD). Thirty-four COPD patients were included in the retrospective cross-sectional study. Hand grip strength and body composition (body massindex (BMI), body fat percent age and fat-free mass (FFM)) measurements were used to evaluated. All measurement results were recorded from patient file. The median value of hand grip strength was 19.66 (14.00-24.37) kg and 58.8% were over weight-obese. A significant correlation was found between handgrip strength and BMI (r=-0.548 p=0.002), body fat percent age (r=-0.701 p<0.001), FFM (r=-0.640 p<0.001). A significant correlation was found between hand grip strength and body composition and functional capacity, severity of dyspnea, presence of comorbidity, physical performance, HRQoL, ranging from weak to strong (p<0.05). Muscle strength and body composition are important inter related factors that increase risk of functional and physical limitations and affect HRQoL in COPD. Muscle strength and body composition should be considered with in scope of pulmonary rehabilitation applications from early period, and therapeutic strategies such as exercise approaches, diet and life style changes should be included to gether to improve these parameters.

References

  • Vogelmeier CF, Criner GJ, Martinez FJ, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive lung disease 2017 report. GOLD executive summary.Am J Respir Crit Care Med 2017;195(5):557-582.
  • Barnes PJ, Celli BR. Systemic manifestations and comorbidities of COPD. Eur Respir J 2009;33(5):1165-1185.
  • Eisner MD, Blanc PD, Yelin EH, et al. COPD as a systemic disease: impact on physical functional limitations. Am J Med 2008;121(9):789-796.
  • Nyberg A, Saey D, Maltais F. Why and How Limb Muscle Mass and Function Should Be Measured in Patients with Chronic Obstructive Pulmonary Disease. Ann Am Thorac Soc 2015;12(9):1269-1277.
  • Schols AM, Broekhuizen R, Weling-Scheepers CA, Wouters EF. Body composition and mortality in chronic obstructive pulmonary disease. Am J Clin Nutr 2005;82(1):53-59.
  • Robles PG, Mathur S, Janaudis-Fereira T, et al. Measurement of peripheral muscle strength in individuals with chronic obstructive pulmonary disease: a systematic review. J CardiopulmRehabil Prev 2011;31(1):11-24.
  • Holden M, Fyfe M, Poulin C, et al. Handgrip Strength in People with Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis. Phys Ther 2021; 101(6):pzab057.
  • Spruit MA, Singh SJ, Garvey C, et al. An official American thoracic society/European respiratory society statement: Key concepts and advances in pulmonary rehabilitation. Am J Respir Crit Care Med 2013; 188: e-13-64.
  • Vermeeren MA, Creutzberg EC, Schols AM, et al; COSMIC Study Group. Prevalence of nutritional depletion in a large out-patient population of patients with COPD. Respir Med 2006;100(8):1349-1355.
  • Joppa P, Tkacova R, Franssen FME, et al. Sarcopenic obesity, functional outcomes, and systemic inflammation in patients with chronic obstructive pulmonary disease. J Am Med Dir Assoc 2016;17:712-718.
  • Patel MS, Mohan D, Andersson YM, et al. Phenotypic characteristics associated with reduced short physical performance battery score in COPD. Chest 2014;145(5):1016-1024.
  • Medina-Mirapeix F, Bernabeu-Mora R, Llamazares-Herrán E, et al. Interobserver Reliability of Peripheral Muscle Strength Tests and Short Physical Performance Battery in Patients with Chronic Obstructive Pulmonary Disease: A Prospective Observational Study. Arch Phys Med Rehabil 2016;97(11):2002-2005.
  • Stanojevic S, Kaminsky DA, Miller MR, et al. ERS/ATS technical standard on interpretive strategies for routine lung function tests. Eur Respir J 2022;60(1):2101499.
  • Mathiowetz V, Kashman N, Volland G, et al. Grip and pinch strength: normative data for adults. Arch Phys Med Rehabil 1985;66(2):69-74.
  • Flegal KM. Epidemiologic aspects of overweight and obesity in the United States. PhysiolBehav 2005;86(5):599-602.
  • Sunjaya A, Poulos L, Reddel H, Jenkins C. Qualitative validation of the modified Medical Research Council (mMRC) dyspnoea scale as a patient-reported measure of breathlessness severity. Respir Med 2022;203:106984.
  • Troosters T, Gosselink R, Decramer M. Sixminute walking distance in healthy elderly subjects. Eur Respir J 1999;14(2):270-274.
  • Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987;40(5):373-383.
  • Guralnik JM, Simonsick EM, Ferrucci L, et al. A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol 1994;49(2):M85-94.
  • Jones PW, Quirk FH, Baveystock CM, Littlejohns P. A self-complete measure of health status for chronic airflow limitation. The St. George's Respiratory Questionnaire. Am Rev Respir Dis 1992;145(6):1321-1327.
  • Polatlı M, Yorgancıoğlu A, Aydemir Ö, ve ark. St. George solunum anketinin Türkçe geçerlilik ve güvenilirliği. Tuberk Toraks 2013;61(2):81-87.
  • Alpar R. Uygulamalı istatistik ve gecerlik-guvenirlik: spor, saglık ve egitim bilimlerinden örneklerle. Ankara: Detay Yayıncılık; 2010.
  • Wu ZY, Han YX, Niu ME, et al. Handgrip strength is associated with dyspnoea and functional exercise capacity in male patients with stable COPD. Int J Tuberc Lung Dis 2019;23(4):428-432.
  • Fonseca J, Machado FVC, Santin LC, et al. Handgrip Strength as a Reflection of General Muscle Strength in Chronic Obstructive Pulmonary Disease. COPD 2021;18(3):299-306.
  • Cruz-Jentoft AJ, Bahat G, Bauer J, et al. Sarcopenia: Revised European consensus on definition and diagnosis. Age Ageing2019;48(4):601.
  • Yamauchi Y, Hasegawa W, Yasunaga H, et al. Paradoxical association between body mass index and in-hospital mortality in elderly patients with chronic obstructive pulmonary disease in Japan. Int J Chron Obstruct Pulmon Dis 2014;9:1337-1346.
  • Nici L, Donner C, Wouters E, et al. American thoracic society/ European respiratory society statement on pulmonary rehabilitation. AJRCCM 2006;173(12):1390-1413.
  • Kyomoto Y, Asai K, Yamada K, et al. Handgrip strength measurement in patients with chronic obstructive pulmonary disease: Possible predictor of exercise capacity. Respir Investig 2019;57(5):499-505.
  • Martínez-Luna N, Orea-Tejeda A, González-Islas D, et al. Association between body composition, sarcopenia and pulmonary function in chronic obstructive pulmonary disease. BMC Pulm Med 2022;22(1):106.
  • Katz P, Iribarren C, Sanchez G, Blanc PD. Obesity and Functioning Among Individuals with Chronic Obstructive Pulmonary Disease (COPD). COPD 2016;13(3):352-359.
  • Köktürk N, KOAH Çalışma Grubu Adına. "TÜRK TORAKS DERNEĞİ'NİN GOLD 2017 Kronik Obstrüktif Akciğer Hastalığı (KOAH) RAPORUNA BAKIŞI." (2017).
  • O’Donnell D, Ciavaglia C, Neder J. When obesity and chronic obstructive pulmonary disease collide. Physiological and clinical consequences. Ann Am Thorac Soc 2014; 11(4):635-644.
  • Mohan D, Benson VS, Allinder M, et al; ERICA Consortium. Short Physical Performance Battery: What Does Each Sub-Test Measure in Patients with Chronic Obstructive Pulmonary Disease? Chronic ObstrPulm Dis 2020;7(1):13-25.
  • Ozalevli S, Ozdena AO, Itil O, Akkoclub A. Comparison of the sit-to-stand test with 6 min walk test in patients with chronic obstructive pulmonary disease. Respir Med 2007;101(2):286-293.
  • Miravitlles M, Soriano JB, García-Río F, et al. Prevalence of COPD in Spain: impact of undiagnosed COPD on quality of life and daily life activities. Thorax 2009;64(10):863-868.
  • Selzler AM, Habash R, Robson L, et al. Self-efficacy and health-related quality of life in chronic obstructive pulmonary disease: A meta-analysis. Patient Educ Couns 2020;103(4):682-692.
  • García-Hermoso A, Cavero-Redondo I, Ramírez-Vélez R, et al. Muscular Strength as a Predictor of All-Cause Mortality in an Apparently Healthy Population: A Systematic Review and Meta-Analysis of Data from Approximately 2 Million Men and Women. Arch Phys Med Rehabil 2018;99(10):2100-2113.e5.
  • Chua JR, Albay AB Jr, Tee ML. Body Composition of Filipino Chronic Obstructive Pulmonary Disease (COPD) Patients in Relation to Their Lung Function, Exercise Capacity and Quality of Life. Int J Chron Obstruct Pulmon Dis 2019;14:2759-2765.

KRONİK OBSTRÜKTİF AKCİĞER HASTALIĞI OLAN HASTALARIN KAS KUVVETİ VE VÜCUT KOMPOZİSYONUNUN FONKSİYONEL KAPASİTE, FİZİKSEL PERFORMANS VE SAĞLIKLA İLGİLİ YAŞAM KALİTESİ İLE İLİŞKİSİNİN İNCELENMESİ: RETROSPEKTİF ÇALIŞMA

Year 2023, , 403 - 410, 04.12.2023
https://doi.org/10.34108/eujhs.1284636

Abstract

Bu çalışmanın amacı; kronik obstrüktif akciğer hastalığı (KOAH) olan hastaların kas kuvveti ve vücut kompozisyonu ile fonksiyonel kapasite, dispne şiddeti, komorbidite varlığı, fiziksel performans ve sağlıkla ilgili yaşam kalitesi arasındaki ilişkinin incelenmesidir. Retrospektif kesitsel tipte olan araştırmaya 34 KOAH hastası alındı. Hastaların kas kuvveti değerlendirmesi için el kavrama kuvveti ve vücut kompozisyonu değerlendirmesi için vücut kütle indeksi (VKİ), vücut yağ yüzdesi ve yağsız vücut kütlesi ölçümleri kullanıldı. Hastaların bütün ölçüm sonuçları hasta dosyasından alınarak kaydedildi. Hastaların el kavrama kuvveti ortanca değeri 19.66 (14.00-24.37) kg idi ve %58.8’i aşırı kilolu-obezdi. Hastaların kavrama kuvveti ile VKİ(r=-0.548 p=0.002), vücut yağ yüzdesi (r=-0.701 p<0.001) ve yağsız vücut kütlesi (r=-0.640 p<0.001) arasında anlamlı bir ilişki bulundu. El kavrama kuvveti ve vücut kompozisyonu ile fonksiyonel kapasite, dispne şiddeti, komorbidite varlığı, fiziksel performans ve sağlıkla ilgili yaşam kalitesi arasında zayıf ile güçlü düzey arasında değişen anlamlı bir ilişki saptandı (p<0.05). Kas kuvveti ve vücut kompozisyonu KOAH'ta fonksiyonel ve fiziksel sınırlama riskini artıran ve yaşam kalitesini etkileyen birbiri ile ilişkili önemli faktörlerdir. Bu nedenle kas kuvveti ve vücut kompozisyonu; erken dönemden itibaren pulmoner rehabilitasyon uygulamaları kapsamında dikkate alınarak değerlendirilmeli ve bu parametreleri geliştirmeye yönelik egzersiz yaklaşımları, diyet ve yaşam tarzı değişiklikleri gibi terapötik stratejilere birlikte yer verilmelidir.

References

  • Vogelmeier CF, Criner GJ, Martinez FJ, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive lung disease 2017 report. GOLD executive summary.Am J Respir Crit Care Med 2017;195(5):557-582.
  • Barnes PJ, Celli BR. Systemic manifestations and comorbidities of COPD. Eur Respir J 2009;33(5):1165-1185.
  • Eisner MD, Blanc PD, Yelin EH, et al. COPD as a systemic disease: impact on physical functional limitations. Am J Med 2008;121(9):789-796.
  • Nyberg A, Saey D, Maltais F. Why and How Limb Muscle Mass and Function Should Be Measured in Patients with Chronic Obstructive Pulmonary Disease. Ann Am Thorac Soc 2015;12(9):1269-1277.
  • Schols AM, Broekhuizen R, Weling-Scheepers CA, Wouters EF. Body composition and mortality in chronic obstructive pulmonary disease. Am J Clin Nutr 2005;82(1):53-59.
  • Robles PG, Mathur S, Janaudis-Fereira T, et al. Measurement of peripheral muscle strength in individuals with chronic obstructive pulmonary disease: a systematic review. J CardiopulmRehabil Prev 2011;31(1):11-24.
  • Holden M, Fyfe M, Poulin C, et al. Handgrip Strength in People with Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis. Phys Ther 2021; 101(6):pzab057.
  • Spruit MA, Singh SJ, Garvey C, et al. An official American thoracic society/European respiratory society statement: Key concepts and advances in pulmonary rehabilitation. Am J Respir Crit Care Med 2013; 188: e-13-64.
  • Vermeeren MA, Creutzberg EC, Schols AM, et al; COSMIC Study Group. Prevalence of nutritional depletion in a large out-patient population of patients with COPD. Respir Med 2006;100(8):1349-1355.
  • Joppa P, Tkacova R, Franssen FME, et al. Sarcopenic obesity, functional outcomes, and systemic inflammation in patients with chronic obstructive pulmonary disease. J Am Med Dir Assoc 2016;17:712-718.
  • Patel MS, Mohan D, Andersson YM, et al. Phenotypic characteristics associated with reduced short physical performance battery score in COPD. Chest 2014;145(5):1016-1024.
  • Medina-Mirapeix F, Bernabeu-Mora R, Llamazares-Herrán E, et al. Interobserver Reliability of Peripheral Muscle Strength Tests and Short Physical Performance Battery in Patients with Chronic Obstructive Pulmonary Disease: A Prospective Observational Study. Arch Phys Med Rehabil 2016;97(11):2002-2005.
  • Stanojevic S, Kaminsky DA, Miller MR, et al. ERS/ATS technical standard on interpretive strategies for routine lung function tests. Eur Respir J 2022;60(1):2101499.
  • Mathiowetz V, Kashman N, Volland G, et al. Grip and pinch strength: normative data for adults. Arch Phys Med Rehabil 1985;66(2):69-74.
  • Flegal KM. Epidemiologic aspects of overweight and obesity in the United States. PhysiolBehav 2005;86(5):599-602.
  • Sunjaya A, Poulos L, Reddel H, Jenkins C. Qualitative validation of the modified Medical Research Council (mMRC) dyspnoea scale as a patient-reported measure of breathlessness severity. Respir Med 2022;203:106984.
  • Troosters T, Gosselink R, Decramer M. Sixminute walking distance in healthy elderly subjects. Eur Respir J 1999;14(2):270-274.
  • Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987;40(5):373-383.
  • Guralnik JM, Simonsick EM, Ferrucci L, et al. A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol 1994;49(2):M85-94.
  • Jones PW, Quirk FH, Baveystock CM, Littlejohns P. A self-complete measure of health status for chronic airflow limitation. The St. George's Respiratory Questionnaire. Am Rev Respir Dis 1992;145(6):1321-1327.
  • Polatlı M, Yorgancıoğlu A, Aydemir Ö, ve ark. St. George solunum anketinin Türkçe geçerlilik ve güvenilirliği. Tuberk Toraks 2013;61(2):81-87.
  • Alpar R. Uygulamalı istatistik ve gecerlik-guvenirlik: spor, saglık ve egitim bilimlerinden örneklerle. Ankara: Detay Yayıncılık; 2010.
  • Wu ZY, Han YX, Niu ME, et al. Handgrip strength is associated with dyspnoea and functional exercise capacity in male patients with stable COPD. Int J Tuberc Lung Dis 2019;23(4):428-432.
  • Fonseca J, Machado FVC, Santin LC, et al. Handgrip Strength as a Reflection of General Muscle Strength in Chronic Obstructive Pulmonary Disease. COPD 2021;18(3):299-306.
  • Cruz-Jentoft AJ, Bahat G, Bauer J, et al. Sarcopenia: Revised European consensus on definition and diagnosis. Age Ageing2019;48(4):601.
  • Yamauchi Y, Hasegawa W, Yasunaga H, et al. Paradoxical association between body mass index and in-hospital mortality in elderly patients with chronic obstructive pulmonary disease in Japan. Int J Chron Obstruct Pulmon Dis 2014;9:1337-1346.
  • Nici L, Donner C, Wouters E, et al. American thoracic society/ European respiratory society statement on pulmonary rehabilitation. AJRCCM 2006;173(12):1390-1413.
  • Kyomoto Y, Asai K, Yamada K, et al. Handgrip strength measurement in patients with chronic obstructive pulmonary disease: Possible predictor of exercise capacity. Respir Investig 2019;57(5):499-505.
  • Martínez-Luna N, Orea-Tejeda A, González-Islas D, et al. Association between body composition, sarcopenia and pulmonary function in chronic obstructive pulmonary disease. BMC Pulm Med 2022;22(1):106.
  • Katz P, Iribarren C, Sanchez G, Blanc PD. Obesity and Functioning Among Individuals with Chronic Obstructive Pulmonary Disease (COPD). COPD 2016;13(3):352-359.
  • Köktürk N, KOAH Çalışma Grubu Adına. "TÜRK TORAKS DERNEĞİ'NİN GOLD 2017 Kronik Obstrüktif Akciğer Hastalığı (KOAH) RAPORUNA BAKIŞI." (2017).
  • O’Donnell D, Ciavaglia C, Neder J. When obesity and chronic obstructive pulmonary disease collide. Physiological and clinical consequences. Ann Am Thorac Soc 2014; 11(4):635-644.
  • Mohan D, Benson VS, Allinder M, et al; ERICA Consortium. Short Physical Performance Battery: What Does Each Sub-Test Measure in Patients with Chronic Obstructive Pulmonary Disease? Chronic ObstrPulm Dis 2020;7(1):13-25.
  • Ozalevli S, Ozdena AO, Itil O, Akkoclub A. Comparison of the sit-to-stand test with 6 min walk test in patients with chronic obstructive pulmonary disease. Respir Med 2007;101(2):286-293.
  • Miravitlles M, Soriano JB, García-Río F, et al. Prevalence of COPD in Spain: impact of undiagnosed COPD on quality of life and daily life activities. Thorax 2009;64(10):863-868.
  • Selzler AM, Habash R, Robson L, et al. Self-efficacy and health-related quality of life in chronic obstructive pulmonary disease: A meta-analysis. Patient Educ Couns 2020;103(4):682-692.
  • García-Hermoso A, Cavero-Redondo I, Ramírez-Vélez R, et al. Muscular Strength as a Predictor of All-Cause Mortality in an Apparently Healthy Population: A Systematic Review and Meta-Analysis of Data from Approximately 2 Million Men and Women. Arch Phys Med Rehabil 2018;99(10):2100-2113.e5.
  • Chua JR, Albay AB Jr, Tee ML. Body Composition of Filipino Chronic Obstructive Pulmonary Disease (COPD) Patients in Relation to Their Lung Function, Exercise Capacity and Quality of Life. Int J Chron Obstruct Pulmon Dis 2019;14:2759-2765.
There are 38 citations in total.

Details

Primary Language Turkish
Subjects Health Care Administration
Journal Section Research Article
Authors

Hazal Yakut 0000-0003-4918-9249

Musa Eymir 0000-0002-9671-9583

Sevgi Özalevli 0000-0002-5528-1036

Aylin Özgen Alpaydın 0000-0002-5711-1372

Early Pub Date November 3, 2023
Publication Date December 4, 2023
Submission Date April 17, 2023
Published in Issue Year 2023

Cite

APA Yakut, H., Eymir, M., Özalevli, S., Alpaydın, A. Ö. (2023). KRONİK OBSTRÜKTİF AKCİĞER HASTALIĞI OLAN HASTALARIN KAS KUVVETİ VE VÜCUT KOMPOZİSYONUNUN FONKSİYONEL KAPASİTE, FİZİKSEL PERFORMANS VE SAĞLIKLA İLGİLİ YAŞAM KALİTESİ İLE İLİŞKİSİNİN İNCELENMESİ: RETROSPEKTİF ÇALIŞMA. Sağlık Bilimleri Dergisi, 32(3), 403-410. https://doi.org/10.34108/eujhs.1284636
AMA Yakut H, Eymir M, Özalevli S, Alpaydın AÖ. KRONİK OBSTRÜKTİF AKCİĞER HASTALIĞI OLAN HASTALARIN KAS KUVVETİ VE VÜCUT KOMPOZİSYONUNUN FONKSİYONEL KAPASİTE, FİZİKSEL PERFORMANS VE SAĞLIKLA İLGİLİ YAŞAM KALİTESİ İLE İLİŞKİSİNİN İNCELENMESİ: RETROSPEKTİF ÇALIŞMA. JHS. December 2023;32(3):403-410. doi:10.34108/eujhs.1284636
Chicago Yakut, Hazal, Musa Eymir, Sevgi Özalevli, and Aylin Özgen Alpaydın. “KRONİK OBSTRÜKTİF AKCİĞER HASTALIĞI OLAN HASTALARIN KAS KUVVETİ VE VÜCUT KOMPOZİSYONUNUN FONKSİYONEL KAPASİTE, FİZİKSEL PERFORMANS VE SAĞLIKLA İLGİLİ YAŞAM KALİTESİ İLE İLİŞKİSİNİN İNCELENMESİ: RETROSPEKTİF ÇALIŞMA”. Sağlık Bilimleri Dergisi 32, no. 3 (December 2023): 403-10. https://doi.org/10.34108/eujhs.1284636.
EndNote Yakut H, Eymir M, Özalevli S, Alpaydın AÖ (December 1, 2023) KRONİK OBSTRÜKTİF AKCİĞER HASTALIĞI OLAN HASTALARIN KAS KUVVETİ VE VÜCUT KOMPOZİSYONUNUN FONKSİYONEL KAPASİTE, FİZİKSEL PERFORMANS VE SAĞLIKLA İLGİLİ YAŞAM KALİTESİ İLE İLİŞKİSİNİN İNCELENMESİ: RETROSPEKTİF ÇALIŞMA. Sağlık Bilimleri Dergisi 32 3 403–410.
IEEE H. Yakut, M. Eymir, S. Özalevli, and A. Ö. Alpaydın, “KRONİK OBSTRÜKTİF AKCİĞER HASTALIĞI OLAN HASTALARIN KAS KUVVETİ VE VÜCUT KOMPOZİSYONUNUN FONKSİYONEL KAPASİTE, FİZİKSEL PERFORMANS VE SAĞLIKLA İLGİLİ YAŞAM KALİTESİ İLE İLİŞKİSİNİN İNCELENMESİ: RETROSPEKTİF ÇALIŞMA”, JHS, vol. 32, no. 3, pp. 403–410, 2023, doi: 10.34108/eujhs.1284636.
ISNAD Yakut, Hazal et al. “KRONİK OBSTRÜKTİF AKCİĞER HASTALIĞI OLAN HASTALARIN KAS KUVVETİ VE VÜCUT KOMPOZİSYONUNUN FONKSİYONEL KAPASİTE, FİZİKSEL PERFORMANS VE SAĞLIKLA İLGİLİ YAŞAM KALİTESİ İLE İLİŞKİSİNİN İNCELENMESİ: RETROSPEKTİF ÇALIŞMA”. Sağlık Bilimleri Dergisi 32/3 (December 2023), 403-410. https://doi.org/10.34108/eujhs.1284636.
JAMA Yakut H, Eymir M, Özalevli S, Alpaydın AÖ. KRONİK OBSTRÜKTİF AKCİĞER HASTALIĞI OLAN HASTALARIN KAS KUVVETİ VE VÜCUT KOMPOZİSYONUNUN FONKSİYONEL KAPASİTE, FİZİKSEL PERFORMANS VE SAĞLIKLA İLGİLİ YAŞAM KALİTESİ İLE İLİŞKİSİNİN İNCELENMESİ: RETROSPEKTİF ÇALIŞMA. JHS. 2023;32:403–410.
MLA Yakut, Hazal et al. “KRONİK OBSTRÜKTİF AKCİĞER HASTALIĞI OLAN HASTALARIN KAS KUVVETİ VE VÜCUT KOMPOZİSYONUNUN FONKSİYONEL KAPASİTE, FİZİKSEL PERFORMANS VE SAĞLIKLA İLGİLİ YAŞAM KALİTESİ İLE İLİŞKİSİNİN İNCELENMESİ: RETROSPEKTİF ÇALIŞMA”. Sağlık Bilimleri Dergisi, vol. 32, no. 3, 2023, pp. 403-10, doi:10.34108/eujhs.1284636.
Vancouver Yakut H, Eymir M, Özalevli S, Alpaydın AÖ. KRONİK OBSTRÜKTİF AKCİĞER HASTALIĞI OLAN HASTALARIN KAS KUVVETİ VE VÜCUT KOMPOZİSYONUNUN FONKSİYONEL KAPASİTE, FİZİKSEL PERFORMANS VE SAĞLIKLA İLGİLİ YAŞAM KALİTESİ İLE İLİŞKİSİNİN İNCELENMESİ: RETROSPEKTİF ÇALIŞMA. JHS. 2023;32(3):403-10.