COPD (Chronic Obstructive Pulmonary Disease)Manuel TherapyGait BiomechanicsMuscle Energy TechniqueFunctional Capacity
Investigational drug(s) / intervention(s)
Manual therapy GroupControl group
Manual therapy Group: For muscle energy techniques, the post-isometric relaxation (PIR) technique will be applied. Participants will be instructed to perform an isometric contraction against mild resistance (20-30% of maximal effort), which will be maintained for 7-10 seconds, followed by a 3-second relaxation period. PIR applications will be performed bilaterally for each muscle group, in 2 sets with a total of 10 repetitions. The muscle groups to which MET will be applied include the pectoralis major and minor, upper trapezius, scalene muscles, sternocleidomastoid, and latissimus dorsi. For the diaphragmatic relaxation technique, the therapist will follow the elevation of the ribs and gently draw the contact points cranially and slightly laterally. During expiration, the therapist will maintain resistance by deepening the contact toward the internal costal margin. The maneuver will be applied in two sets of 10 deep breaths, with a 1-minute rest interval between sets.
Control group: Self-stretching and breathing exercise
Study summary
The primary aim of this study is to investigate the effects of manual therapy on spatiotemporal characteristics of gait and gait variability, functional exercise capacity, and pulmonary function in patients with chronic obstructive pulmonary disease (COPD).
The secondary aims of the study are to determine the effects of manual therapy on balance, respiratory muscle strength, quality of life, physical activity, symptom severity, accessory respiratory muscle activation, peripheral muscle strength, chest wall mobility, dysfunctional breathing, pain, and posture.
Eligibility
Sex
ALL
Min age
40 Years
Max age
—
Healthy volunteers
No
Inclusion Criteria:
* Age 40 years or older
* Clinically stable for at least the past 4 weeks
* Classified as GOLD stage 1, 2, or 3 according to the Global Initiative for Chronic Obstructive Pulmonary Disease (GOLD) airflow limitation classification
* Classified as group A, B, or E according to the GOLD ABE assessment tool
Exclusion Criteria:
* Use of walking assistive devices
* Receiving long-term oxygen therapy
* Presence of additional orthopedic, neuromuscular, neurological, or cardiac conditions that may affect gait and balance
* History of lung cancer, sarcoidosis, tuberculosis, and/or lung surgery
* Presence of musculoskeletal conditions such as fibromyalgia, rheumatoid arthritis, or osteoarthritis
* Presence of a known mental or cognitive impairment
Primary outcome measure(s)
Spatiotemporal Gait Characteristics (Gait Analysis) — At the baseline and after the eight-week intervention The spatiotemporal characteristics of gait and gait variability will be assessed using an electronic walkway system (GAITRite, CIR Systems Inc., Franklin, New Jersey, USA). GAITRite is a system with established reliability and validity for gait assessment in individuals with COPD. Data will be collected at the beginning and at the end of a six-minute walking period. Participants will walk at their self-selected pace. Gait data obtained at the beginning and at the end of the six-minute walk will be averaged for data analysis. Data normalization will be performed using participants' leg length (cm), height (cm), or body weight (kg) values.
Spatial Gait Distance Parameters — At the baseline and after the eight-week intervention Mean step length, stride length, and step width measured using the GAITRite electronic walkway system. Unit of Measure: meters (m)
Temporal Gait Parameters — At the baseline and after the eight-week intervention Mean stance phase duration, swing phase duration, stride time, and step time assessed using GAITRite.
Unit of Measure: seconds (s)
Gait Speed — At the baseline and after the eight-week intervention Mean walking speed measured using the GAITRite system during self-selected pace walking.
Unit of Measure: meters per second (m/s)
Cadence — At the baseline and after the eight-week intervention Mean cadence assessed using GAITRite during the six-minute walk test. Unit of Measure: steps per minute (steps/min)
Gait Symmetry and Asymmetry Indices — At the baseline and after the eight-week intervention Right-left gait symmetry and asymmetry indices derived from spatiotemporal gait parameters.
Unit of Measure: ratio or percentage (%)
Gait Variability Parameters — At the baseline and after the eight-week intervention Stride time variability, step time variability, and step width variability calculated from GAITRite data.
Unit of Measure: coefficient of variation (%)
Functional exercise capacity — At the baseline and after the eight-week intervention Functional exercise capacity will be assessed using the Six-Minute Walk Test (6MWT). The test will be conducted in accordance with the criteria of the American Thoracic Society (ATS). Heart rate and peripheral oxygen saturation (SpO₂) will be measured using a pulse oximeter (Nonin Model 2500C, Nonin Medical, Inc., Plymouth, Minnesota, USA), and blood pressure will be measured using a sphygmomanometer (Erka Perfect Aneroid, Berlin, Germany) before the test, at the first minute, and immediately after the test. Leg fatigue, general fatigue, and dyspnea will be assessed using the Modified Borg Scale. At the end of the test, the total distance walked will be recorded in meters. Predicted values based on age, sex, height, and body weight will be used to calculate the percentage of the predicted walking distance achieved by each participant. To evaluate mechanical workload, the 6MWT workload will be calculated by multiplying the six-minute walking distance by the participant's body weight.
Pulmonary Functions — At baseline and after the eight-week intervention Pulmonary functions will be assessed using spirometry in accordance with the guidelines published by the American Thoracic Society (ATS) and the European Respiratory Society (ERS). Forced expiratory volume in one second (FEV₁) will be recorded.
FEV₁ expressed as a percentage of predicted values based on reference equations. Unit of Measure: Percentage (%)
Based on spirometry results, airflow limitation in COPD will be classified according to the Global Initiative for Chronic Obstructive Pulmonary Disease (GOLD) criteria, with FEV₁/FVC \< 0.70 defined for all groups. Classification will be as follows:
* GOLD 1 (Mild): FEV₁ ≥ 80% of predicted
* GOLD 2 (Moderate): 50% ≤ FEV₁ \< 80% of predicted
* GOLD 3 (Severe): 30% ≤ FEV₁ \< 50% of predicted
* GOLD 4 (Very severe): FEV₁ \< 30% of predicted
Forced Vital Capacity (FVC) — At the baseline and after the eight-week intervention Forced vital capacity (FVC) measured by spirometry following ATS/ERS standards. Unit of Measure: Liters (L) an persantage (%)
FEV₁/FVC Ratio — At the baseline and after the eight-week intervention The ratio of forced expiratory volume in one second to forced vital capacity (FEV₁/FVC) obtained from spirometry.
Unit of Measure: Ratio
Peak Expiratory Flow (PEF) — At the baseline and after the eight-week intervention Peak expiratory flow assessed by spirometry according to ATS/ERS guidelines. Unit of Measure: Liters per second (L/s) and persentage (%)
Forced Expiratory Flow 25-75% (FEF₂₅-₇₅) — At the baseline and after the eight-week intervention Forced expiratory flow between 25% and 75% of forced vital capacity measured using spirometry.
Unit of Measure: Liters per second (L/s) and persentage
This page summarises publicly available registry data for informational purposes — not medical advice. Eligibility is determined by each study team; patients should discuss participation with their clinician.
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