Title : Thoracic mobility and six minute walk test performance of frail elderly suffering from chronic obstructive pulmonary disease
Abstract:
Chronic obstructive pulmonary disease (COPD) is a long term inflammatory airway disease which is due to hampered air flow from/to the lungs. Its symptoms usually aggravate over time; difficulty in breathing, shortness of breath. People with COPD also have a threatening risk for other health issues. These include respiratory infections, pulmonary cancer, cardiac problems, weak muscles and brittle bones, depression and anxiety. COPD is mainly made distinctive by two main conditions- 1) Emphysema 2) Chronic bronchitis.
Frailty is a medical syndrome resulting from various factors, marked by decreased strength, endurance, and diminished physiological function or reserve. Frality having components of sarcopenia, weight loss and decreased physical activity - produces decreased mobility in COPD individuals leading to slower movements and decreased level of physiocal activity, it also produces decreased chest mobility and movement of the respiratory diphragm. Full chest mobility requires physical exertion and deep breaths with arm movements, these are not present in such individuals, however in the form of erercises they may help to preserve respiratory function. Specifically targetting the chest mobility has not been popular and is not found very commonly in the available literature though the exercise intervention of the diverse nature are reported commonly.
Aimed to evaluate the effects of thoracic mobility exercises combined with respiratory muscle exercises and respiratory muscle exercises alone on the 6-minute walk test (6MWT) performance in COPD patients with frailty. N=74 COPD patients diagnosed with frailty were randomly assigned to two groups: Group A (n=37) received thoracic mobility exercises along with respiratory muscle exercises, while Group B (n=37) received only respiratory muscle exercises. Frailty was assessed using the Fried scale, which evaluates based on five criteria: unintentional weight loss of ≥5 kg within the past year, fatigue, low physical activity (weekly kcal below 383 in men and 270 in women), slow gait, and weak grip strength (< 20% of the sex) (Spielmanns et al., 2023). Patients were classified as frail- if they met 3 or more criteria, pre-frail if they met 1 or 2, and non-frail if they met none. Pre-intervention 6MWT assessments were conducted for both groups. Subsequently, they attended three sessions per week for six weeks. Post-intervention 6MWT assessments were performed to evaluate changes in walking distance and functional capacity. Both groups exhibited significant improvements in 6MWT performance (p<0.05) after the six-week intervention period. However, Group A, receiving thoracic mobility exercises combined with respiratory muscle exercises, demonstrated a greater improvement in distance walked compared to Group B, which received respiratory muscle exercises alone. This research was done to know the effectiveness of thoracic mobility and respiratory exercises on pulmonary function and subjective experiences of breathlessness in chronic obstructive pulmonary disease (COPD) patients with frailty. This inefficiency can lead to increased work of breathing and respiratory fatigue, contributing to symptoms such as dyspnea and exercise intolerance.The results indicate that both thoracic mobility exercises and respiratory muscle exercises contribute to improved functional capacity however, the combination of thoracic mobility exercises with respiratory muscle exercises resulted in superior outcomes. These findings signify the benefits of incorporating thoracic mobility and respiratory muscles in the management of COPD patients with frailty.
Clinical Relevance: COPD stands as a prominent contributor to illness globally, persisting as one of the primary three reasons for mortality (Verduri et al., 2024). This rise is attributable to continual exposure to risk factors and the aging demographic of the global population(Naval et al., 2021). Frailty is a medical syndrome stemming from various factors, marked by decreased strength, endurance, and diminished physiological function or reserves (Akuzum et al., 2024). Incorporating thoracic wall mobility and respiratory exercises as a fundamental aspect of respiratory rehabilitation could enhance the overall outcomes for patients, optimizing their rehabilitation progress in Chronic obstructive pulmonary disease patients. Studies have shown that interventions aimed at enhancing thoracic wall mobility also lead to improvements in lung function, functional capacity, exercise capacity, dyspnea, and chest wall mechanics and volume distribution in individuals with obstructive lung diseases (Huang et al., 2023). The 6-minute walk distance (6MWT) evaluates how far a person can walk in 6 minutes without having symptoms of breathlessness. It's widely acknowledged as a reliable predictor for mortality, hospital admissions, and exacerbations among COPD patients.
