Effects of Otago Exercise Program vs Circuit Training on Balance in Chronic Obstructive Pulmonary Disease Patients
Condition: COPD
MeSH terms: Lung Diseases; Lung Diseases, Obstructive; Pulmonary Disease, Chronic Obstructive
Study type: Interventional

Summary: 
      The study is designed to compare circuit training and otago exercise program for improvement
      of balance in COPD patients. Although both techniques are effective for balance training but
      Otago exercise program is home-based exercise program, which, if proven effective, will help
      the COPD patients to do work up at home, thereby reducing cost of hospital visits and
      improving balance ability and thus the quality of life more effectively.
    

Detailed description: 
      Chronic obstructive pulmonary disease (COPD) is a respiratory disease that result in
      progressive restriction of airflow and respiratory distress and is the 4th leading cause of
      death. In specific, it happens among smokers over the age of 40 and individuals exposed to
      biomass smoke. The prevalence of COPD is expected to increase as the population ages.
      Pakistan is a lower-middle-income country, and facing a high burden of chronic obstructive
      pulmonary diseases. The prevalence of COPD among Pakistani adults aged more than 40 years is
      2.1% In addition to pulmonary symptoms, patients with chronic obstructive pulmonary disease
      develop many other manifestations of the disease, such as cardiovascular co morbidities,
      peripheral muscle dysfunction, weight loss, systemic inflammation, and psychological
      problems. People also have reduced capacity for exercise and functional mobility. Among all,
      one important extra respiratory manifestation is impaired balance. It is a frequent problem
      in stable COPD and increases with the severity of the disease. As in COPD there is loss of
      body cells which causes skeletal muscle weakness and balance impairment.

      Since skeletal muscle dysfunction in people with COPD is a commonly identified impairment, it
      is not surprising that lower-limb muscle weakness has also been linked in this population to
      balance deficits and increased risk of falling. Muscle strength in both the upper and lower
      extremities is reduced in COPD patients along with impairments in exercise tolerance.

      Pulmonary rehabilitation (PR) is an effective COPD intervention that involves exercise
      training and psychosocial support, and patient education to achieve maximum community
      independence and function. This recommended standard of care, however, focuses primarily on
      training peripheral muscles through endurance and strength training and does not include a
      particular training component. The effective intervention to successfully reduce both the
      rate and risk of falling has been shown to be exercise with balance-specific training.

      As COPD decreases the amount of physical activity, even early in the disease phase, and
      impairs the strength of the lower limb muscle thus affecting balance. Balance training
      protocols together with pulmonary rehabilitation exercises helps to improve balance and
      symptoms of COPD. Although both circuit training and Otago exercise program are effective for
      balance training but Otago exercise program is home-based exercise program, which, if proven
      effective, will help the COPD patients to do work up at home, thereby reducing cost of
      hospital visits and improving balance ability and thus the quality of life more effectively.
    

Intervention name(s): Otago Exercise training; Circuit training
Intervention type(s): Other; Other
Intervention description(s): Warm-up exercises. Chair March, Arm swings ( 30 second), Head movement, neck movement, back extension, trunk movement, ankle movement (repeat 5 times).
Back of thigh stretch, calf stretch, (hold for 8 seconds).
Strengthening exercises Front knee strengthening, back knee strengthening, side hip strengthening (2 or more sets of 10 reps) Calf raises, toe raises (repeat this exercises 10 to 20 times)
Balance improvement exercises Knee bends, heel-toe standing, heel toes walking, one leg stand ( start with 5 sec move up to 10 sec) Side walk, heel walking, sit to stand, backwards walking, heel toes walking backwards, walking and turning around, stair walking (10 steps).
Cool-down session Back of thigh stretch, calf stretches ( 10 to 20 sec hold, 1 to 3 reps)
Pulmonary rehabilitation program
Daily breathing exercises (e.g. diaphragmatic, pursed lip breathing).
Stretch exercise for major respiratory muscles.; Functional strength exercises Heel raise, toe raise, walking on toes, step ups in all directions ( forward, backward and sideways) (2 sets and 8 reps)
Stance exercises Tandem, narrow, one leg stance, and stand on uneven surfaces with open eyes (each exercise 30 seconds) Tandem, narrow, one leg stance, and stand on uneven surfaces with eyes closed (each exercise 15seconds).
Transition exercises Sit to stand from chair with arms (10 reps) and then without arms support (5 reps).
Sit on floor and stand up with assistance and then without assistance.
Gait training Walking tandem, sideway and backward with arm support. Walking tandem, sideway and backward without arm support Walking tandem, sideway and backward over obstacles
Pulmonary rehabilitation program
Daily breathing exercises (e.g. diaphragmatic, pursed lip breathing).
Stretch exercise for major respiratory muscles
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Chronic obstructive pulmonary disease (COPD); Pulmonary rehabilitation; Balance; Otago exercise; Circuit training