Comparison of the Effects of Different Chest Techniques on University Students With Smoking Addiction

Condition(s) studied

Investigational drug(s) / intervention(s)

Chest PNF Techniques Group: The combined isotonic contraction technique will be used to improve respiratory control. In all positions, the patient is asked to exhale first. Pressure and stretching are applied in the opposite direction of the movement. As the patient inhales, resistance is controlled. Supine position: Both hands are placed on the sternum and oblique downward pressure is applied. The hands are placed parallel and diagonally along the lateral chest wall, above the lower ribs. To focus on the upper chest region, the hands are similarly placed on the pectoral muscles. Side-lying position: Both hands are placed parallel and diagonally along the lateral chest wall above the lower ribs. This position is beneficial to resist chest movement in the lower region and thus distribute the force to chest movement in the upper region. Prone position: The hands are placed parallel and diagonally along the lower ribs. In the forearm position, one hand is placed on the sternum and the other on the intercostal region

Chest Mobility Exercises Group: Chest rotation, Passive lateral flexion while lying on the side, Mobilization of the thoracic facet joint while lying on the back, Trunk rotation in sitting position, Moving the arm in front of the chest while sitting, Cat-camel exercise, Pectoral stretch, Chest mobility in crawling position.

Study summary

Smoking is a significant risk factor for heart, lung, and respiratory system diseases, and is particularly prevalent among young people and university students. In Turkey, tobacco use is high in the 15-24 age group, and smoking rates among university students are reported to be between 20% and 43%. Besides causing COPD and other respiratory diseases, smoking negatively impacts performance by increasing fatigue, dyspnea, and pain during exercise. It impairs lung function, reducing respiratory volumes such as FVC and FEV1. PNF and chest mobility exercises targeting the chest area can improve respiratory parameters by increasing respiratory muscle function and thoracic mobility. Recent studies show that chest PNF techniques have positive effects on lung function, chest expansion, and some physiological parameters, especially in smokers.

Eligibility

Primary outcome measure(s)

• Dyspnea Assessment — Baseline and through study completion, an average of 6 weeks
  Modified Medical Research Council -mMRC: The mMRC used for dyspnea assessment consists of five stages. Stage 0 represents mild dyspnea, and Stage 4 represents severe dyspnea (Bestall et al., 1999).
• Pulmonary Function Testing — Baseline and through study completion, an average of 6 weeks
  Measurements are taken with a portable spirometer (Cosmed Pony FX, Cosmed, Rome, Italy) while the patient is in a seated position. Forced expiratory volume in one second (FEV1) is measured (Miller et al., 2005).
• Pulmonary Function Testing — Baseline and through study completion, an average of 6 weeks
  Measurements are taken with a portable spirometer (Cosmed Pony FX, Cosmed, Rome, Italy) while the patient is in a seated position. Forced vital capacity (FVC) is measured (Miller et al., 2005).
• Pulmonary Function Testing — Baseline and through study completion, an average of 6 weeks
  Measurements are taken with a portable spirometer (Cosmed Pony FX, Cosmed, Rome, Italy) while the patient is in a seated position. The ratio of forced expiratory volume in one second to forced vital capacity (FEV1/FVC) is measured (Miller et al., 2005).
• Pulmonary Function Testing — Baseline and through study completion, an average of 6 weeks
  Measurements are made with a portable spirometer (Cosmed Pony FX, Cosmed, Rome, Italy) with the patient in a sitting position. Peak expiratory flow rate (PEF) are measured (Miller et al., 2005).
• Pulmonary Function Testing — Baseline and through study completion, an average of 6 weeks
  Measurements are made with a portable spirometer (Cosmed Pony FX, Cosmed, Rome, Italy) with the patient in a sitting position. Flow rate at 25-75% of forced vital capacity (FEF 25-75%) are measured (Miller et al., 2005)
• Pulmonary Function Testing — Baseline and through study completion, an average of 6 weeks
  Measurements are made with a portable spirometer (Cosmed Pony FX, Cosmed, Rome, Italy) with the patient in a sitting position. Vital capacity (VC) are measured (Miller et al., 2005).
• Respiratory Muscle Strength Measurement — Baseline and through study completion, an average of 6 weeks
  Maximal inspiratory pressure measurements (MIP) will be taken. For the MIP measurement, the participant sits in a chair and, with a nose clip attached, is asked to take a maximum inspiration through the mouth for 1-3 seconds (Neder et al., 1999)
• Respiratory Muscle Strength Measurement — Baseline and through study completion, an average of 6 weeks
  Maximal expiratory pressure measurements (MEP) will be taken. For the MEP measurement, the participant is asked to take a maximum inspiration and then a maximum expiration for 1-3 seconds. After performing both measurements three times, the best reading is recorded (Neder et al., 1999).
• Exercise Capacity Assessment — Baseline and through study completion, an average of 6 weeks
  Six-Minute Walk Test - 6MWT: The six-minute walk test is one of the most frequently used field tests in clinical settings due to its practicality and low cost, assessing submaximal functional capacity. The test is conducted in a 30-meter corridor. After being informed about the test, the participant is asked to walk in a marked area in the corridor for six minutes, and the total distance is recorded. It is recommended that it be performed three times at regular intervals throughout the day, and the best distance recorded. The patient may stop and rest at any time and use assistive devices if available. Blood pressure, heart rate, oxygen saturation, fatigue, and dyspnea are measured before and after the test. In individuals with COPD, a walk of \<350 meters is associated with lower exercise capacity and increased mortality risk (Ceylan, 2014). A 6-minute walk will result in a report calculating the total distance walked in meters.
• Depression Assessment (Beck Depression Inventory-BDI) — Baseline and through study completion, an average of 6 weeks
  The BDI is a scale used to assess depression. It consists of 21 items, each with four options. The scale has a scoring system of 0-3. The lowest score a participant can receive on this scale is 0 and the highest is 63. Higher scores indicate increasing levels of depression. Total scores are divided into 4 groups: 0-9 points: "minimal depression," 10-16 points: "mild depression," 17-29 points: "moderate depression," and 30 points and above: "severe depression." The Turkish reliability study of this scale was conducted by Hisli in 1988 (Hisli, 1989).
• Physical Activity Level Assessment — Baseline and through study completion, an average of 6 weeks
  Short Form of the International Physical Activity Questionnaire-IPAQ-SF: This questionnaire, whose validity and reliability in Turkish were developed by Sağlam et al., consists of 7 questions. It asks about vigorous and moderate physical activities, including walking and sitting activities, performed within the last week, on how many days per week and for how long. Sitting activity is not included in the scoring section (Sağlam et al., 2010). MET values of the activities were used as 8 METs for vigorous physical activities, 4 METs for moderate physical activities, and 3.3 METs for walking, and the total score was recorded as MET-min/week. The total duration (minutes) and frequency (days) of each are required for score calculation. The MET score is obtained by multiplying the MET value of the activity by the number of days and minutes. The results are evaluated in three categories: inactive, moderately active, and active: Inactive, Moderately active, Active (Craig et al., 2003).
• Quality of Life Assessment — Baseline and through study completion, an average of 6 weeks
  Patients' quality of life will be assessed using the Short Form-36 (SF-36). It consists of eight sub-items: physical function, social function, role limitations due to physical problems, pain, vitality, mental health, and general health perception. Each sub-item is scored between 0 and 100, and these scores are not added together. A high score indicates good health. The Turkish validity and reliability study of the scale was conducted by Demiral et al. (Demiral et al., 2006).
• Chest Expansion Measurement — Baseline and through study completion, an average of 6 weeks
  Chest expansion was assessed by measuring the circumference of the chest wall at maximum inspiration and maximum expiration. Measurements were taken with a measuring tape at the axillary (level of the 4th rib), epigastric (level of the xiphoid process), and subcostal (above the 11th and 12th ribs) levels while the person was in an upright sitting position. Participants were asked to perform maximum inspiration and expiration, and the difference between the two was recorded in centimeters. Each measurement was repeated three times for each of the three regions (Otman and Köse, 2014).
• Fatigue Assessment — Baseline and through study completion, an average of 6 weeks
  Patients' fatigue was assessed using the Turkish adaptation of the Fatigue Severity Scale (Appendix-6). The scale consists of 9 questions, and patients were asked to indicate their response using a number from 1 to 7, with 1 indicating complete disagreement and 7 indicating complete agreement. The possible score range for the questionnaire is 9-63 (Gencay-Can and Can, 2012; Armutlu et al., 2007).
• Harvard Step Test — Baseline and through study completion, an average of 6 weeks
  This test, used to measure cardiopulmonary endurance and physical fitness, involves individuals climbing and descending steps for 5 minutes. During ascent and descent, the feet must switch positions and remain side-by-side. Heart rate and oxygen levels are measured before and after the test. Heart rate is measured at 1, 2, and 3 minutes after the test ends. The result is calculated as: (Test duration (seconds) x 100) / (Sum of 2 x recovery heart rates) (Mackenzie, 2005). Results are scored as follows: 90 and above excellent, 80-89 good, 65-79 moderate, 55-64 poor, and 54 and below very poor (Babu et al., 2015).

Trial sites (1)

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