EFFECTIVENESS OF SHOULDER AND THORACIC MOBILITY EXERCISES ON CHEST EXPANSION AND DYSPNOEA IN MODERATE CHRONIC OBSTRUCTIVE PULMONARY DISEASE PATIENTS

Materials and Methods: It was an experimental study carried out at the pulmonology department of Krishna hospital, Karad. A total of 40 subjects were selected by convenient sampling and they were randomly allocated into two groups .Group A received conventional chest physiotherapy and Group B received shoulder and thoracic mobility exercises along with conventional chest physiotherapy. Treatment duration was 30 minutes/session, twice daily for three days. The outcome measures were chest expansion using inch tape and Modified Borg Scale (MBS) for dyspnoea.

in men and 8.77/200 in women [2].COPD is progressive and is characterized acute exacerbation causing breathlessness (dyspnoea), cough and respiratory distress [3].As COPD worsens, quality of life is affected.COPD is suspected when there is history of exposure to risk factors for the disease along with chronic Chronic obstructive pulmonary disease (COPD) is characterized by chronic airflow limitation of the airways, which can be prevented but cannot be reversed [1].COPD is a currently the fourth leading cause of death in the world.Prevalence of COPD in 2002 was estimated to be 11.6/200During arm exercise, the accessory muscles of respiration are required for the arm task and may not be able to contribute breathing.In addition, since the muscles that move that arm and stabilize the trunk are attached to the rib cage, this increases chest wall impedance, which limits the ability to increase tidal volume during activities.It is these impairments in ventilator mechanics which result in termination of arm exercise at low workload for people with COPD compared to healthy subjects [2].Supported upper limb activities increases the functional residual capacity due to a stretch of thoracic muscles imposed on the rib cage when the arms are raised with weights it strengthens the upper limb muscles and concluded that supported arm activities improves its endurance and quality of life.A supported arm exercise along with coordinated breathing exercises reduces the rate of dyspnoea and improves the  Both the groups will be advised to continue their normal activity and follow their inhaler and medications prescribed by the chest physician.For MBS post (p=<0.0001)considered extremely significant difference and pre value (p=0.6909) is considered not significant between A and B.
The results from the statistical analysis of the present study supported the alternative hypothesis which stated that there will be beneficial effect to the subjects treated with shoulder and thoracic mobility exercises along with conventional chest physiotherapy therapy.For MBS post (p=<0.0001)considered extremely significant difference and pre value (p=0.6909) is considered not significant between A and B.
The results from the statistical analysis of the present study supported the alternative hypothesis which stated that there will be beneficial effect to the subjects treated with shoulder and thoracic mobility exercises along with conventional chest physiotherapy therapy.
Hence above results showed that Group B subjects treated with shoulder and thoracic mobility exercises along with conventional therapy showed better improvement in chest expansion and reduction of dyspnoea.Thus it can be stated from above study that physical therapy interventions like shoulder and thoracic mobility exercises are more efficacious and cost effective.ABBREVATIONS COPD -Chronic Obstructive Pulmonary Disease MBS -Modified Borg scale.
Sonia U Mulay, T. Poovishnu Devi, Vaishali Krishnat Jagtap.EFFECTIVENESS OF SHOULDER AND THORACIC MOBILITY EXERCISES ON CHEST EXPANSION AND DYSPNOEA IN MODERATE CHRONIC OBSTRUCTIVE PULMONARY DISEASE PATIENTS.perform their major action to sustain the shoulder girdle in position as a consequence, the respiratory work is shifted to the diaphragm which is already at a mechanical disadvantage in patients with COPD [1].Patients with COPD frequently experience dyspnoea during normal daily activities when they use their upper extremity.During arm exercise, the etiology of the dyspnoea may relate to dynamic hyperinflation, thoracoabdominal dyssynchrony, changes in ventilator and postural muscle recruitment and/or general peripheral muscle reconditioning (related to less use) with decreased upper extremity strength and endurance in the face of increased ventilator and metabolic demands.Exercise capacity is impaired in COPD, both peak exercise capacity and functional exercise capacity .Besides lung hyperinflation and physical inactivity, ventilation-perfusion mismatch, hypoxemia, cardiovascular problems and muscular changes contribute to reduced exercise capacity [4].Arm training improves work effort and dynamic hyperinflation and dyspnoea.Furthermore, arm exercise may lead to greater upper extremity exercises and improves exercise capacity, reduced ventilation and oxygen consumption during arm activities.
ability to perform the arm activities without restrictions.Aerobic and strength training in patients with COPD concluded that the combination of strength training and aerobic training showed significant improvement in patients with COPD.Upper limb exercise training improves work capacity and endurance and reduces the oxygen consumption during workload.Arm training positively influenced peak arm exercise capacity, metabolic and ventilator demand and also improved activities of daily living.MATERIALS AND METHODS weight 3. External rotators with weights 4. Internal rotators with weight 5.Shoulder shrugged exercise 6. Shoulder flexion from 0 o -180 o 7.Shoulder extension from 180 o o 8.Shoulder horizontal abduction 8. Shoulder horizontal adduction.Dosage: • Frequency-2 times/day.• Treatment duration-3 days.• No. of repetitions-15.• No of sets-3 • Total duration-30 minutes.Along with that thoracic mobility exercises Sitting: Procedure: The patient should exhale while bending forward to touch the floor with arms crossed at the feet then the patients should extend up while taking a deep inspiration and lift the arm up arm up for 3 days, 3 sets of 10 repetitions.Standing: Procedure:The patient should stand with his knees straight, the patient instructed to exhale while bending forward to touch the floor with arms; then the patient should extend up by lifting his hands simultaneously taking a deep inspiration for 3 days, 3 sets of 10 repetitions.Conventional chest physiotherapy includes: • Percussion • Vibration • Shaking Breathing exercises: • Pursed lip breathing • Diaphragmatic breathing • Glosso-pharyngeal breathing.• Deep coughing.• Forced expiratory technique Control group was treated with only conventional chest physiotherapy.

Table 1 :
Comparison of pre-values of chest expansion at axillary level between the groups.

Table 2 :
Comparison of pre-values of chest expansion at Nipple level between the groups.

Table 3 :
Comparison of pre-values of chest expansion at level between the groups.

Table 4 :
Comparison of post-values of chest expansion at axillary level between the groups.

Table 5 :
Comparison of post-values of chest expansion at nipple level between the groups.

Table 6 :
Comparison of post-values of chest expansion at xiphisternal level between the groups.

Table 7 :
Comparison of pre-values and post-values of chest expansion at axillary level within the groups.

Table 8 :
Comparison of pre-values and post-values of chest expansion at nipple level within the groups.

Table 9 :
Comparison of pre-values and post-values of chest expansion at xiphisternal level within the groups.

Table 10 :
Comparison of pre-values of Modified Borg scale between the groups.

Table 11 :
Comparison of post-values of Modified Borg scale between the groups.

Table 12 :
Comparison of pre-values and post-values of Modified Borg Scale within the groups.Dyspnoea is the most debilitating condition aspects of COPD that leads to disability and poor quality of life resulting in frequent access to rehabilitation.COPD is a currently the fourth leading cause of death in the world.Prevalence of COPD in 2002 was estimated to be 11.6/1000 in men and 8.77/1000 in women.So the present clinical trial was conducted to find out the effect of shoulder and thoracic mobility exercises on chest expansion and dyspnoea in moderate COPD patients.40 subjects clinically diagnosed with COPD and fulfilling inclusion and exclusion criteria with age between 35 to 45 years were included in the study.Further they were classified according to GOLD classification as stage 2 (Moderate COPD).They were allocated into two groups, Sonia U Mulay, T. Poovishnu Devi, Vaishali Krishnat Jagtap.EFFECTIVENESS OF SHOULDER AND THORACIC MOBILITY EXERCISES ON CHEST EXPANSION AND DYSPNOEA IN MODERATE CHRONIC OBSTRUCTIVE PULMONARY DISEASE PATIENTS.Group A and Group B, each containing 20 subjects.A conventional chest physiotherapy treatment was given in Group A and baseline or conventional chest physiotherapy treatment with an addition to shoulder and thoracic mobility exercises in Group B. The outcome was measured by chest expansion with inch and Modified Borg Scale.extremely significant and difference for chest expansion at axillary level, nipple level, xiphisternal level and score of modified Borg scale post 3 days of treatment (p < 0.0001), (p < 0.0001), (p < 0.0001), (p < 0.0001) for group B. Unpaired t test and Mann Whitney test was used to analyse the effect of shoulder and thoracic mobility exercises on chest expansion measurement and dyspnoea between the for pre values of chest expansion at axillary level, nipple level, xiphisternal level (p=0.6993)(p=0.5177)(p=0.4728).
The average mean age of participants in Group A was 40.75± 2.971 and Group B was 40.9± 2.972, which showed there is no significant difference in age of subjects in both groups (t = 0.1596 & p = 0.8740)) which was done by unpaired t-test.The total number of participants included over 40 out of which 23 were males and 17 were females.Group A contained 11 males and 9 females and Group B had 12 males and 8 females.Paired t test and wilcoxon matched pairs test was used to analyse the effect of shoulder and thoracic mobility exercises on chest expansion measurement and dyspnoea within the groups.There was extremely significant and considered significant difference for chest expansion at axillary level, nipple level, xiphisternal level and score of modified Borg scale post 3 days of treatment (p=0.0286),(p=0.0358),(p =0.0298), (p < 0.0001) for A group and there was groups.There was considered extremely significant difference for post values of chest expansion at axillary level, nipple level, xiphisternal level (p<0.0001),(p<0.0001),(p<0.0001) and there was considered not significant difference