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The Effects of Respiratory Functions and Respiratory Muscle Strength on Exercise Capacity and Quality of Life in Patients with Ankylosing Spondylitis

Yıl 2022, Cilt: 11 Sayı: 3, 1202 - 1210, 27.09.2022
https://doi.org/10.37989/gumussagbil.1136090

Öz

This study aims to examine the effects of impaired respiratory functions and respiratory muscle strength (RMS) on exercise capacity and quality of life in patients with ankylosing spondylitis (AS). In the study, 28 AS patients (female: 20, male: 8; age: 41.93±9.49) and 28 healthy individuals (female: 20, male: 8; age: 39.61±10.78) were evaluated. Descriptive information, clinical histories and chest expansion measurements of the patients were obtained. Respiratory function tests (RFT) were measured with a spirometer and RMS was measured with a respiratory pressure meter. Disease activity was assessed with the Bath Ankylosing Spondylitis Functional Index (BASFI). Functional exercise capacity was measured using the 6-min walk test (6MWT) and vital signs. SF-36 quality of life scale was used to evaluate the quality of life of the patient group. The average values of RFT, RMS, 6MWT and vital signs of patients with AS were found to be lower than the control group. FEV1, 6MWT, leg fatigue before and after 6MWT and heart rate after 6MWT parameters were significantly lower in AS patients than in control group (p<0.05). In addition, a negative correlation was found between RFT, RMS and BASFI score of the patient group and a positive correlation was found between 6MWT, chest expansion and quality of life parameters. In conclusion, this study showed that the impairments in the musculoskeletal system and respiratory functions in AS patients decrease their respiratory parameters, exercise capacity and quality of life. Exercises that increase RMS should be included in the exercise programs for AS.

Kaynakça

  • 1. Braun, J. and Sieper, J. (2007). “Ankylosing Spondylitis”. The Lancet, 369 (9570), 1379-1390.
  • 2. Cho, H, Kim, T, Kim, T.H, Lee, S. and Lee, K.H. (2013). “Spinal Mobility, Vertebral Squaring, Pulmonary Function, Pain, Fatigue, and Quality of Life in Patients With Ankylosing Spondylitis”. Annals of Rehabilitation Medicine, 37 (5), 675.
  • 3. Yan, F, Reddy, P.D, Nguyen, S.A, Ward, C. and Meyer, T.A. (2021). “Hearing Loss in Patients with Ankylosing Spondylitis: A Systematic Review and Metaanalysis”. The Journal of Rheumatology, 48 (1), 40-47.
  • 4. El Maghraoui, A. (2011). “Extra-Articular Manifestations of Ankylosing Spondylitis: Prevalence, Characteristics and Therapeutic Implications”. European Journal of Internal Medicine, 22 (6), 554-560.
  • 5. Berdal, G, Halvorsen, S, Van Der Heijde, D, Mowe, M. and Dagfinrud, H. (2012). “Restrictive Pulmonary Function is More Prevalent in Patients with Ankylosing Spondylitis Than in Matched Population Controls and is Associated with Impaired Spinal Mobility: A Comparative Study”. Arthritis Research and Therapy, 14 (1), 1-10.
  • 6. Donath, J. and Miller, A. (2009). “Restrictive Chest Wall Disorders”. Semin in Respiratory and Critical Care Medicine, 30, 275-292
  • 7. Sampaio-Barros, P.D, Cerqueira, E.M.F, Rezende, S.M, Maeda, L, Conde, R.A, Zanardi, V.A. and Samara, A.M. (2007). “Pulmonary Involvement in Ankylosing Spondylitis”. Clinical Rheumatology, 26 (2), 225-230.
  • 8. Wong, M.L, Anderson, R.G, Garcia, K, Housmann, E.M, McHale, E, Goldberger, G.S. and Cahalin, L.P. (2017). “The Effect of Inspiratory Muscle Training on Respiratory Variables in A Patient with Ankylosing Spondylitis: A Case Report”. Physiotherapy Theory and Practice, 33 (10), 805-814.
  • 9. Quismorio Jr, F.P. (2006). “Pulmonary Involvement in Ankylosing Spondylitis”. Current Opinion in Pulmonary Medicine, 12 (5), 342-345.
  • 10. Romagnoli, I, Gigliotti, F, Galarducci, A, Lanini, B, Bianchi, R, Cammelli, D. and Scano, G. (2004). “Chest Wall Kinematics and Respiratory Muscle Action in Ankylosing Spondylitis Patients”. European Respiratory Journal, 24 (3), 453-460.
  • 11. Falkenbach, A. and Curda, B. (2001). “Symptoms, Effects on Quality of Life, Judgement and Expectations of Treatment in Active Ankylosing Spondylitis: The Patient's View”. Die Rehabilitation, 40 (5), 275-279.
  • 12. Ince, G, Sarpel, T, Durgun, B. and Erdogan, S. (2006). “Effects of A Multimodal Exercise Program for People with Ankylosing Spondylitis”. Physical Therapy, 86 (7), 924-935.
  • 13. World Medical Association. (2013). “World Medical Association Declaration of Helsinki: Ethical Principles for Medical Research Involving Human Subjects”. Jama, 310 (20), 2191-2194.
  • 14. Hsieh, L.F, Wei, J.C.C, Lee, H.Y, Chuang, C.C., Jiang, J.S. and Chang, K.C. (2016). “Aerobic Capacity and Its Correlates in Patients with Ankylosing Spondylitis”. International Journal of Rheumatic Diseases, 19 (5), 490-499.
  • 15. American Thoracic Society. (2002). “ATS/ERS Statement on Respiratory Muscle Testing”. Am J Respir Crit Care Med, 166, 518-624.
  • 16. Lomax, M, Tasker, L. and Bostanci, O. (2015). “An Electromyographic Evaluation of Dual Role Breathing and Upper Body Muscles in Response to Front Crawl Swimming”. Scandinavian Journal of Medicine and Science in Sports, 25 (5), e472-e478.
  • 17. Bostanci, Ö, Mayda, H, Yılmaz, C, Kabadayı, M, Yılmaz, A.K. and Özdal, M. (2019). “Inspiratory Muscle Training Improves Pulmonary Functions and Respiratory Muscle Strength in Healthy Male Smokers”. Respiratory Physiology and Neurobiology, 264, 28-32.
  • 18. ATS statement: guidelines for the six-minute walk test. (2002). “ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories”. Am J Respir Crit Care Med, 166 (1), 111-117.
  • 19. Chorus, A.M.J, Miedema, H.S, Boonen, A. and Van Der Linden, S.J. (2003). “Quality of Life and Work in Patients with Rheumatoid Arthritis and Ankylosing Spondylitis of Working Age”. Annals of The Rheumatic Diseases, 62 (12), 1178-1184.
  • 20. Sieper, J, Rudwaleit, M, Baraliakos, X, Brandt, J, Braun, J, Burgos-Vargas, R. and Van Der Heijde, D. (2009). “The Assessment of Spondylo Arthritis International Society (ASAS) Handbook: A Guide to Assess Spondyloarthritis”. Annals of the Rheumatic Diseases, 68 (Suppl 2), 1-44.
  • 21. Casserly, I.P, Fenlon, H.M, Breatnach, E. and Sant, S.M. (1997). “Lung Findings on High-Resolution Computed Tomography in Idiopathic Ankylosing Spondylitis--Correlation with Clinical Findings, Pulmonary Function Testing and Plain Radiography”. British Journal of Rheumatology, 36 (6), 677-682.
  • 22. Inanici, F. and Hasçelik, Z. (2011). “Reduced Vital Capacity Leads to Exercise Intolerance in Patients with Ankylosing Spondylitis”. European Journal of Physical and Rehabilitation Medicine, 47 (3), 391-397.
  • 23. Calik, B.B, Kabul, E.G, Taskın, H, Atalay, O.T, Aslan, U.B, Tascı, M. and Yıldız, A.I. (2018). “The Efficiency of Inspiratory Muscle Training in Patients with Ankylosing Spondylitis”. Rheumatology International, 38 (9), 1713-1720.
  • 24. O’Dwyer, T, O’Shea, F. and Wilson, F. (2014). “Exercise Therapy for Spondyloarthritis: A Systematic Review”. Rheumatology International, 34 (7), 887-902.
  • 25. Drăgoi, R.G, Amaricai, E, Drăgoi, M, Popoviciu, H. and Avram, C. (2016). “Inspiratory Muscle Training Improves Aerobic Capacity and Pulmonary Function in Patients with Ankylosing Spondylitis: A Randomized Controlled Study”. Clinical Rehabilitation, 30 (4), 340-346.
  • 26. Van Der Esch, M, Van't Hul, A.J, Heijmans, M. and Dekker, J. (2004). “Respiratory Muscle Performance as A Possible Determinant of Exercise Capacity in Patients with Ankylosing Spondylitis”. Australian Journal of Physiotherapy, 50 (1), 41-45.
  • 27. Analay, Y, Ozcan, E, Karan, A, Diracoglu, D. and Aydin, R. (2003). “The Effectiveness of Intensive Group Exercise on Patients with Ankylosing Spondylitis”. Clinical Rehabilitation, 17 (6), 631-636.
  • 28. Türk, A.Ç, Arslan, S, Karavelioğlu, Y, Kalcik, M, Özel, S, Musmul, A. and Şahin, F. (2019). “Pulmonary Function, Aerobic Capacity and Related Variables in Patients with Ankylosing Spondylitis”. Archives of Rheumatology, 34 (3), 317.
  • 29. Kawassaki, A.M, Pereira, D.A.S, Kay, F.U, Laurindo, I.M.M., Carvalho, C.R.R. and Kairalla, R.A. (2015). “Pulmonary Involvement in Rheumatoid Arthritis: Evaluation by Radiography and Spirometry”. Jornal Brasileiro de Pneumologia, 41, 331-342.
  • 30. Jonsson, K. and Peterson, M. (2019). “Peak Expiratory Flow Rate and Thoracic Mobility in People with Fibromyalgia. A Cross Sectional Study”. Scandinavian Journal of Pain, 19 (4), 755-763.
  • 31. Dincer, U, Cakar, E, Kiralp, M.Z, Bozkanat, E, Kilac, H. and Dursun, H. (2007). “The Pulmonary Involvement in Rheumatic Diseases: Pulmonary Effects of Ankylosing Spondylitis and Its Impact on Functionality and Quality of Life”. The Tohoku Journal of Experimental Medicine, 212 (4), 423-430.

Ankilozan Spondilitli Hastaların Solunum Fonksiyonları ve Solunum Kas Kuvvetlerinin Egzersiz Kapasitesi ile Yaşam Kalitesi Üzerine Etkisi

Yıl 2022, Cilt: 11 Sayı: 3, 1202 - 1210, 27.09.2022
https://doi.org/10.37989/gumussagbil.1136090

Öz

Bu çalışmanın amacı Ankilozan Spondilitli hastaların (AS) bozulan solunum fonksiyonları ile solunum kas kuvvetlerinin (SKK) egzersiz kapasitesi ve yaşam kalitesi üzerine etkisini incelemektir. Araştırmada AS tanısı almış olan 28 hasta (kadın: 20, erkek: 8; yaş: 41.93±9.49) ve 28 sağlıklı birey (kadın: 20, erkek: 8; yaş: 39.61±10.78) değerlendirildi. Hastaların tanımlayıcı bilgileri, klinik öyküleri ve göğüs ekspansiyon ölçümleri alındı. Solunum fonksiyon testleri (SFT) spirometre ile SKK ağız içi basınç ölçer ile ölçüldü. Hastalık aktivitesi, Bath Ankilozan Spondilit Fonksiyonel İndeksi (BASFI) ile değerlendirildi. Fonksiyonel egzersiz kapasitesi 6 dakikalık yürüme testi (6DYT) ve vital bulguları kullanılarak ölçüldü. Hasta grubunun yaşam kalitesini değerlendirmek için ise SF-36 yaşam kalitesi ölçeğinden yararlanıldı. AS’li hastaların SFT, SKK, 6DYT ve vital bulguları ortalama değerleri kontrol grubuna göre daha düşük olduğu bulunmuştur. FEV1, 6DYT, 6DYT öncesi ve sonrası bacak yorgunluğu ile 6DYT sonrası nabız parametreleri AS’li hastalarda kontrol grubuna göre istatiksel olarak daha düşüktür (p<0,05). Ayrıca hasta grubunun BASFI skoru ile SFT ve SKK arasında negatif; 6DYT, göğüs ekspansiyonu ve yaşam kalitesi parametreleri arasında pozitif ilişki olduğu tespit edildi. Bu çalışma AS’lilerde kas iskelet sisteminde ve solunum fonksiyonlarında meydana gelen bozulmaların hastaların solunum değerlerini, egzersiz kapasitelerini ve yaşam kalitelerini azalttığını göstermiştir. AS’liler için egzersiz programlarında SKK'yi artıran egzersizlere yer verilmelidir.

Kaynakça

  • 1. Braun, J. and Sieper, J. (2007). “Ankylosing Spondylitis”. The Lancet, 369 (9570), 1379-1390.
  • 2. Cho, H, Kim, T, Kim, T.H, Lee, S. and Lee, K.H. (2013). “Spinal Mobility, Vertebral Squaring, Pulmonary Function, Pain, Fatigue, and Quality of Life in Patients With Ankylosing Spondylitis”. Annals of Rehabilitation Medicine, 37 (5), 675.
  • 3. Yan, F, Reddy, P.D, Nguyen, S.A, Ward, C. and Meyer, T.A. (2021). “Hearing Loss in Patients with Ankylosing Spondylitis: A Systematic Review and Metaanalysis”. The Journal of Rheumatology, 48 (1), 40-47.
  • 4. El Maghraoui, A. (2011). “Extra-Articular Manifestations of Ankylosing Spondylitis: Prevalence, Characteristics and Therapeutic Implications”. European Journal of Internal Medicine, 22 (6), 554-560.
  • 5. Berdal, G, Halvorsen, S, Van Der Heijde, D, Mowe, M. and Dagfinrud, H. (2012). “Restrictive Pulmonary Function is More Prevalent in Patients with Ankylosing Spondylitis Than in Matched Population Controls and is Associated with Impaired Spinal Mobility: A Comparative Study”. Arthritis Research and Therapy, 14 (1), 1-10.
  • 6. Donath, J. and Miller, A. (2009). “Restrictive Chest Wall Disorders”. Semin in Respiratory and Critical Care Medicine, 30, 275-292
  • 7. Sampaio-Barros, P.D, Cerqueira, E.M.F, Rezende, S.M, Maeda, L, Conde, R.A, Zanardi, V.A. and Samara, A.M. (2007). “Pulmonary Involvement in Ankylosing Spondylitis”. Clinical Rheumatology, 26 (2), 225-230.
  • 8. Wong, M.L, Anderson, R.G, Garcia, K, Housmann, E.M, McHale, E, Goldberger, G.S. and Cahalin, L.P. (2017). “The Effect of Inspiratory Muscle Training on Respiratory Variables in A Patient with Ankylosing Spondylitis: A Case Report”. Physiotherapy Theory and Practice, 33 (10), 805-814.
  • 9. Quismorio Jr, F.P. (2006). “Pulmonary Involvement in Ankylosing Spondylitis”. Current Opinion in Pulmonary Medicine, 12 (5), 342-345.
  • 10. Romagnoli, I, Gigliotti, F, Galarducci, A, Lanini, B, Bianchi, R, Cammelli, D. and Scano, G. (2004). “Chest Wall Kinematics and Respiratory Muscle Action in Ankylosing Spondylitis Patients”. European Respiratory Journal, 24 (3), 453-460.
  • 11. Falkenbach, A. and Curda, B. (2001). “Symptoms, Effects on Quality of Life, Judgement and Expectations of Treatment in Active Ankylosing Spondylitis: The Patient's View”. Die Rehabilitation, 40 (5), 275-279.
  • 12. Ince, G, Sarpel, T, Durgun, B. and Erdogan, S. (2006). “Effects of A Multimodal Exercise Program for People with Ankylosing Spondylitis”. Physical Therapy, 86 (7), 924-935.
  • 13. World Medical Association. (2013). “World Medical Association Declaration of Helsinki: Ethical Principles for Medical Research Involving Human Subjects”. Jama, 310 (20), 2191-2194.
  • 14. Hsieh, L.F, Wei, J.C.C, Lee, H.Y, Chuang, C.C., Jiang, J.S. and Chang, K.C. (2016). “Aerobic Capacity and Its Correlates in Patients with Ankylosing Spondylitis”. International Journal of Rheumatic Diseases, 19 (5), 490-499.
  • 15. American Thoracic Society. (2002). “ATS/ERS Statement on Respiratory Muscle Testing”. Am J Respir Crit Care Med, 166, 518-624.
  • 16. Lomax, M, Tasker, L. and Bostanci, O. (2015). “An Electromyographic Evaluation of Dual Role Breathing and Upper Body Muscles in Response to Front Crawl Swimming”. Scandinavian Journal of Medicine and Science in Sports, 25 (5), e472-e478.
  • 17. Bostanci, Ö, Mayda, H, Yılmaz, C, Kabadayı, M, Yılmaz, A.K. and Özdal, M. (2019). “Inspiratory Muscle Training Improves Pulmonary Functions and Respiratory Muscle Strength in Healthy Male Smokers”. Respiratory Physiology and Neurobiology, 264, 28-32.
  • 18. ATS statement: guidelines for the six-minute walk test. (2002). “ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories”. Am J Respir Crit Care Med, 166 (1), 111-117.
  • 19. Chorus, A.M.J, Miedema, H.S, Boonen, A. and Van Der Linden, S.J. (2003). “Quality of Life and Work in Patients with Rheumatoid Arthritis and Ankylosing Spondylitis of Working Age”. Annals of The Rheumatic Diseases, 62 (12), 1178-1184.
  • 20. Sieper, J, Rudwaleit, M, Baraliakos, X, Brandt, J, Braun, J, Burgos-Vargas, R. and Van Der Heijde, D. (2009). “The Assessment of Spondylo Arthritis International Society (ASAS) Handbook: A Guide to Assess Spondyloarthritis”. Annals of the Rheumatic Diseases, 68 (Suppl 2), 1-44.
  • 21. Casserly, I.P, Fenlon, H.M, Breatnach, E. and Sant, S.M. (1997). “Lung Findings on High-Resolution Computed Tomography in Idiopathic Ankylosing Spondylitis--Correlation with Clinical Findings, Pulmonary Function Testing and Plain Radiography”. British Journal of Rheumatology, 36 (6), 677-682.
  • 22. Inanici, F. and Hasçelik, Z. (2011). “Reduced Vital Capacity Leads to Exercise Intolerance in Patients with Ankylosing Spondylitis”. European Journal of Physical and Rehabilitation Medicine, 47 (3), 391-397.
  • 23. Calik, B.B, Kabul, E.G, Taskın, H, Atalay, O.T, Aslan, U.B, Tascı, M. and Yıldız, A.I. (2018). “The Efficiency of Inspiratory Muscle Training in Patients with Ankylosing Spondylitis”. Rheumatology International, 38 (9), 1713-1720.
  • 24. O’Dwyer, T, O’Shea, F. and Wilson, F. (2014). “Exercise Therapy for Spondyloarthritis: A Systematic Review”. Rheumatology International, 34 (7), 887-902.
  • 25. Drăgoi, R.G, Amaricai, E, Drăgoi, M, Popoviciu, H. and Avram, C. (2016). “Inspiratory Muscle Training Improves Aerobic Capacity and Pulmonary Function in Patients with Ankylosing Spondylitis: A Randomized Controlled Study”. Clinical Rehabilitation, 30 (4), 340-346.
  • 26. Van Der Esch, M, Van't Hul, A.J, Heijmans, M. and Dekker, J. (2004). “Respiratory Muscle Performance as A Possible Determinant of Exercise Capacity in Patients with Ankylosing Spondylitis”. Australian Journal of Physiotherapy, 50 (1), 41-45.
  • 27. Analay, Y, Ozcan, E, Karan, A, Diracoglu, D. and Aydin, R. (2003). “The Effectiveness of Intensive Group Exercise on Patients with Ankylosing Spondylitis”. Clinical Rehabilitation, 17 (6), 631-636.
  • 28. Türk, A.Ç, Arslan, S, Karavelioğlu, Y, Kalcik, M, Özel, S, Musmul, A. and Şahin, F. (2019). “Pulmonary Function, Aerobic Capacity and Related Variables in Patients with Ankylosing Spondylitis”. Archives of Rheumatology, 34 (3), 317.
  • 29. Kawassaki, A.M, Pereira, D.A.S, Kay, F.U, Laurindo, I.M.M., Carvalho, C.R.R. and Kairalla, R.A. (2015). “Pulmonary Involvement in Rheumatoid Arthritis: Evaluation by Radiography and Spirometry”. Jornal Brasileiro de Pneumologia, 41, 331-342.
  • 30. Jonsson, K. and Peterson, M. (2019). “Peak Expiratory Flow Rate and Thoracic Mobility in People with Fibromyalgia. A Cross Sectional Study”. Scandinavian Journal of Pain, 19 (4), 755-763.
  • 31. Dincer, U, Cakar, E, Kiralp, M.Z, Bozkanat, E, Kilac, H. and Dursun, H. (2007). “The Pulmonary Involvement in Rheumatic Diseases: Pulmonary Effects of Ankylosing Spondylitis and Its Impact on Functionality and Quality of Life”. The Tohoku Journal of Experimental Medicine, 212 (4), 423-430.
Toplam 31 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Sağlık Kurumları Yönetimi
Bölüm Araştırma Makaleleri
Yazarlar

Şule Özbay Kaya 0000-0001-5399-2101

Özgür Bostancı 0000-0002-7952-1014

Muhammet Hakan Mayda 0000-0002-7062-3284

Yayımlanma Tarihi 27 Eylül 2022
Yayımlandığı Sayı Yıl 2022 Cilt: 11 Sayı: 3

Kaynak Göster

APA Özbay Kaya, Ş., Bostancı, Ö., & Mayda, M. H. (2022). The Effects of Respiratory Functions and Respiratory Muscle Strength on Exercise Capacity and Quality of Life in Patients with Ankylosing Spondylitis. Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi, 11(3), 1202-1210. https://doi.org/10.37989/gumussagbil.1136090
AMA Özbay Kaya Ş, Bostancı Ö, Mayda MH. The Effects of Respiratory Functions and Respiratory Muscle Strength on Exercise Capacity and Quality of Life in Patients with Ankylosing Spondylitis. Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi. Eylül 2022;11(3):1202-1210. doi:10.37989/gumussagbil.1136090
Chicago Özbay Kaya, Şule, Özgür Bostancı, ve Muhammet Hakan Mayda. “The Effects of Respiratory Functions and Respiratory Muscle Strength on Exercise Capacity and Quality of Life in Patients With Ankylosing Spondylitis”. Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi 11, sy. 3 (Eylül 2022): 1202-10. https://doi.org/10.37989/gumussagbil.1136090.
EndNote Özbay Kaya Ş, Bostancı Ö, Mayda MH (01 Eylül 2022) The Effects of Respiratory Functions and Respiratory Muscle Strength on Exercise Capacity and Quality of Life in Patients with Ankylosing Spondylitis. Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi 11 3 1202–1210.
IEEE Ş. Özbay Kaya, Ö. Bostancı, ve M. H. Mayda, “The Effects of Respiratory Functions and Respiratory Muscle Strength on Exercise Capacity and Quality of Life in Patients with Ankylosing Spondylitis”, Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi, c. 11, sy. 3, ss. 1202–1210, 2022, doi: 10.37989/gumussagbil.1136090.
ISNAD Özbay Kaya, Şule vd. “The Effects of Respiratory Functions and Respiratory Muscle Strength on Exercise Capacity and Quality of Life in Patients With Ankylosing Spondylitis”. Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi 11/3 (Eylül 2022), 1202-1210. https://doi.org/10.37989/gumussagbil.1136090.
JAMA Özbay Kaya Ş, Bostancı Ö, Mayda MH. The Effects of Respiratory Functions and Respiratory Muscle Strength on Exercise Capacity and Quality of Life in Patients with Ankylosing Spondylitis. Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi. 2022;11:1202–1210.
MLA Özbay Kaya, Şule vd. “The Effects of Respiratory Functions and Respiratory Muscle Strength on Exercise Capacity and Quality of Life in Patients With Ankylosing Spondylitis”. Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi, c. 11, sy. 3, 2022, ss. 1202-10, doi:10.37989/gumussagbil.1136090.
Vancouver Özbay Kaya Ş, Bostancı Ö, Mayda MH. The Effects of Respiratory Functions and Respiratory Muscle Strength on Exercise Capacity and Quality of Life in Patients with Ankylosing Spondylitis. Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi. 2022;11(3):1202-10.