Effect of abdominal muscle exercise on peak expiratory flow rate in patients with COPD-A RANDOMISED CONTROL TRAIL

INTRODUCTION:

Respiratory muscles are generally classified into two types: Primary or major respiratory muscles and accessory respiratory muscles. Inspiration is an active process. Primary inspiratory muscles are Diaphragm, External intercostal, interconal part of internal intercostal muscles. Accessory muscles include sternocleidomastoid, scalene, upper trapezius, and pectoralis major and minor. At rest, expiration is passive process and achieved through the elastic recoil of the lung and thoracic cage but during forceful expiration additional muscles can be used, are abdominals. The abdominal muscles include Rectus abdominis, external oblique, internal oblique, transverse abdominis. They are regarded as powerful expiratory muscles. It is suggested that expiratory muscles are prone to fatigue that subsequently impairs pulmonary function. Now-a-days as the lifestyle and pollution has direct impact on respiratory system even for normal individuals, the demand will place a greater emphasis on maximizing the patient’s independence, minimizing the disabilities and increasing the patient’s functional status so their quality of life may improve. Respiratory muscle training has effects on pulmonary function and physical performance in both healthy and cardiopulmonary disease populations. Also, non-respiratory maneuvers have been found to activate the diaphragm to varying degrees depending on type of exercise. Abdominal muscle strengthening exercises may be useful in increasing abdominal muscle endurance, also pulmonary functions

Aim of the study is to discover how abdominal exercises affect the Peak Expiratory Flow Rate (PEFR) in COPD patients.

NEED FOR THE STUDY: Abdominal muscle
strengthening exercise is safe and beneficial for any normal individual.
Which can improve peak expiratory flow rate which improves quality of life.
As studies have in been conducted in normal healthy individuals and in
females but not in COPD patients coming to rural hospital, so this study will
show the effect of  abdominal muscle
exercise on peak expiratory flow rate in patients with COPD coming to rural
hospital.

AIM:  To check the effect of abdominal muscle exercise on peak expiratory flow rate in patients with COPD coming to rural hospital

OBJECTIVE OF THE STUDY:  To increase Peak Expiratory Flow Rate through abdominal muscle strengthening exercises in COPD patients.

REVIEW OF LITERATURE:

**1)**Vidhi D. Thakkar et al (2023):  This study suggests that individuals may benefit from performing non respiratory activities such as upper and lower abdominal muscle exercise that can be clinically implied to improve respiratory parameters, cough mechanism and in cardiovascular rehabilitation program.  The study concludes that, there is statistically improvement in PEFR and abdominal muscle endurance after four weeks of abdominal muscle exercises in healthy females. The Improvement was also clinically significant. Thus, the present study accepts the experimental hypothesis and reject the null hypothesis

2) Shweta Modi et al (2021): The study was carried out to know the effect of abdominal muscle exercises on Peak Expiratory Flow Rate in middle age females. The result from the statistical analysis of the present study found that there is a beneficial effect of peak expiratory flow rate on the subjects treated with abdominal muscle strengthening exercises. The mean values of data from present study indicates that subjects showed better peak expiratory flow rate after 15 days of abdominal strengthening exercises. The increase in peak expiratory flow rate is most likely due to the abdominal muscles’ facilitator function, which improves the diaphragm’s ability to produce pressure during respiration. This study concludes that abdominal muscle exercises are beneficial in improving peak expiratory flow rate in middle age females. Hence, regular abdominal muscle strengthening exercises can be done to improve strength of abdominal muscles which in turn help in forceful expiration which can be beneficial in clearing cough out of airways, enhancing cough reflex thereby improving quality of life of individuals.

3) Ishida H et al (2014):  The purpose of this study was to determine whether forced expiration is correlated with abdominal muscle thickness. Twenty-three healthy male volunteers participated in this study. The peak expiratory flow (PEF) was obtained using a peak flow meter with subjects in the sitting position. The thicknesses of the right rectus abdominis, external oblique, internal oblique, and transverse abdominis muscles were measured using B-mode ultrasonography at the end of a relaxed expiration in the supine position. The results show that among the abdominal muscles, only the thickness of the external oblique muscle displayed a significant correlation with PEF. The study concludes that  the thickness of the external oblique muscle might be associated with PEF during forced expiration[3]

4) Bijal pasad et al (2020):  The purpose of this study was to find the effect of abdominal muscle exercises on peak expiratory flow rate in obese individuals. 4 weeks of abdominal strengthening protocol was given to obese subjects who had a decrease in peak expiratory flow rate. The sample consisted of 20 obese individuals. Prior to the abdominal muscle exercises the peak expiratory flow rate was noted and then after 4 weeks again the peak expiratory flow rate was recorded. The study concluded that there is significant effect of abdominal muscle exercises on peak expiratory flow rate in obese individuals.[4]

5) **Kedar KV et al (2017):**This a study on the effect of menopause on pulmonary functions. It concludes that as menopause sets in, decrease in hormonal levels leads to decreased lung capacity as evident by pulmonary function tests. Decreased pulmonary function test can be attributed to lower levels of sex hormones estrogen and progesterone in postmenopausal women. The predicted values of PEFR were lower in postmenopausal women compared with premenopausal women.[5]

RESEARCH QUESTION: What will be the effect of abdominal muscle exercise on peak expiratory flow rate in patients with COPD ?

HYPOTHESES

Null Hypothesis (H0): There will be no significant effect of  abdominal muscle exercise on peak expiratory flow rate in patients with COPD .

Alternative Hypothesis (H1):  There will be a significant  effect of abdominal muscle exercise on peak expiratory flow rate in patients with COPD .

METHODOLOGY:

SOURCE OF DATA: Samples will be collected from Pravara Rural Hospital , Loni.

STUDY SETTING: Study will be conducted in the in -patient department of cardiorespiratory physiotherapy at Dr. APJ Abdul Kalam College of Physiotherapy.

STUDY TYPE: Interventional study.

DURATION OF THE STUDY: 1 Year

SAMPLE SIZE: 30

STUDY POPULATION: COPD patients in rural setup

MATERIAL TO BE USED: 1) Peak expiratory flow meter

Inclusion criteria:

1.     Both Males and Females.

2.     participants diagnosed with COPD

3.     mild and moderate COPD according to gold criteria.

4.     Ability to perform abdominal exercises

5.     Patients between 30-60 years of age group.

Exclusion criteria :

1)     recent abdominal or thoracic surgery

2)     Severe cognitive impairment

3)     Inability to understand

4) Presence of any musculoskeletal or neurological condition

**Outcome Measures:**Peak Expiratory Flow Rate.

PROCEDURE:

·       Ethical clearance will be obtained from the institute.

·       A total no of 30    individuals will be a part of this study. The age criteria being yearsl

·       A written informed consent will be obtained from the participants.

·       Randomly assign participants with two group

·       Grup A will be having abdominal exercise and group B will having conventional exercise

·       Group A participant will be explained the technique of performing the abdominal strengthening exercises.

·       Group B will be having exercise such as Breathing Exercises: Incorporating breathing exercises such as pursed lip breathing and diaphragmatic breathing can help COPD patients improve their breathing mechanics and increase lung capacity. Low-Impact Aerobic Exercises: Activities such as walking, stationary cycling, and swimming are generally well-tolerated by COPD patients.

·       Peak Expiratory Pre intervention Flow Rate will be measuredusing Wright’s Peak Flow Meter of both group.

·       Participants will be asked to perform the test three times, out of them, the best of three trials will be recorded as reading.

·       Patients will be asked to perform abdominal Strengthening Exercises- Upper Abdominals.

·       Exercises will be performed for 1week

·       Post intervention Peak Expiratory Flow Rate will be measured again and recorded.

·       Systemically record data, including exercise adherence, and relevant patient feedback

·        At the end result obtain by mean difference between [post -pre] of PEFR values.

REFFERENCES-

1) Vidhi D. Thakkar, Sweety Shah. Effect of abdominal muscle exercise on peak expiratory flow rate in normal healthy female individuals. Int J Health Sci Res. 2023; 13(4):1-12.

2) Modi S, Shah S. Effect of abdominal curls on peak expiratory flow rate (PEFR) in middle age females. Int J Health Sci Res. 2021; 11(5): 62-66.

3) Ishida H, Kobara K, Osaka H, Suehiro T, Ito T, Kurozumi C, Watanabe S. Correlation between Peak Expiratory Flow and Abdominal Muscle Thickness. J Phys Ther Sci. 2014 Nov;26(11):1791-3. doi: 10.1589/jpts.26.1791. Epub 2014 Nov 13. PMID: 25435702; PMCID: PMC4242957.

4) Bijal pasad, Anagha palkar, Ajay kumar. Effect of abdominal muscle exercises on peak expiratory flow rate in obese individuals. Int j physiotherapy res 2020;8(4):3521-3525.

5) Kedar KV, Munje RP, Karia AK. Effect of Menopause on Pulmonary Functions: An Analysis!. J South Asian Feder Menopause Soc 2017; 5 (2):99-101.