The effectiveness of chest wall mobilisation on respiratory efficiency and functional exercise capacity of patients with severe COPD: a randomised controlled trial

Background and purpose: Restricted chest wall mobility that coexists with lung hyperinflation in patients with chronic obstructive pulmonary disease (COPD) would compromise the efficiency of the respiratory muscle function and work of breathing. Chest wall and thoracic spine mobilizations that aim to stretch the essential respiratory muscles may help promote the chest wall mobility and therefore, enhance the respiratory efficiency amongst those with COPD.

Methods: Thirty male adults (age: 74.97±6.29) suffered from severe degree of COPD were recruited to complete a 6-week pulmonary rehabilitation programme (twice/week) according to the randomisation (chest wall mobilization group, CWMG, n=15; control group, CG, n=15). Both groups received standardized education and walking exercise, while CWMG also received the chest wall and spine mobilisations and exercises. Electromyography (EMG) and tissue oxygen saturation (StO2, measured by near-infrared spectroscopy) of respiratory muscles during incremental cycle exercise test were compared between pre- and post-program, and 3-month follow-up.

Results: At post-program, scalene, sternocleidomastoid and intercostal muscles during exercise test exhibited a significant decrease in their activity (p<0.01) in CWMG, which indicates the better improvement in the exercise tolerance, compared to the CG. There was significant decrease in StO2 (p<0.05) and a greater decline in the slope of oxygenation dissociation (p=0.000) observed in CWMG, which indicates significant greater efficiency of oxygen release and delivery to the intercostal muscle during exercise. Patients in CWMG demonstrated a significantly higher level of exercise from < 3METS to 4-6 METS (p=0.000) after intervention. These listed improvements were well maintained at 3-month follow-up.

Conclusion: Greater exercise tolerance, and efficiency in respiratory muscle function and oxygenation dissociation were found if chest wall and spine mobilizations were integrated in the standardised pulmonary rehabilitation program, in patients with severe degree of COPD.