Effects of PNF D2 Technique With Resistance on Pulmonary Function, Exercise Capacity and Health Status of COPD Patients
Effects of PNF D2 Technique With Resistance on Pulmonary Function, Exercise Capacity and Health Status of COPD Patients
Chronic Obstructive Pulmonary Disease (COPD) is the third leading cause of morbidity and
 disability with 251 million cases per anum reported worldwide. COPD ranks fourth among the
 common causes of mortality with an estimated 3 million annual deaths worldwide that is
 projected to be third by 2020. COPD deaths are more prevalent among the low socio-economic
 developing countries, estimated up to 90% of the total mortality rate across the globe. In
 Asia, 13.5% of the total population suffers with COPD. Particularly, in Pakistan every 10th
 individual suffers with COPD out of which 19.4% are of age above 40 years. Moreover, the
 problem has been identified as a growing public health concern and a challenge for the
 clinicians of 21st century. Consequently, the severity of the condition of patients is
 contributed by exacerbations or co-morbidities, and significant economic burden due to the
 hospitalizations, absence from work and disability; and its management cost from $1544 to
 $2335 in Asian countries, annually. However, specific data economic burden for Pakistan is
 not reported yet. A number of pharmaceutical and non-pharmaceutical treatment options are
 utilized in the management of COPD; however, pulmonary rehabilitation has been conferred as
 the corner stone in management of COPD. NICE guidelines emphasize upon the importance of
 pulmonary rehabilitation for all individuals presenting with COPD; even those who have
 acutely suffered an exacerbation or underwent recent hospitalization. Moreover, pulmonary
 rehabilitation consisting of structured exercises regimes and education regarding self-care
 has been reported to improve COPD symptoms and exercise tolerance; and reduce expenditure of
 resources on recurrent hospitalization and length of stay. Study has reported that resistance
 training demonstrated in better improvement in muscular strength than endurance exercise and
 causes lesser chances of dyspnea while performing activities and is more tolerable than
 endurance exercise regime. Literature is evident upon that the combination of resistance and
 endurance training has shown significant improvement in the respiratory parameters. Hence the
 present study is aimed to incorporate Proprioceptive Neuromuscular Facilitation (PNF) D2
 pattern including different types of resistance training in order to determine the response
 of adjunct therapies on the outcome measures.
Data Collection Procedure:

 The participants will be divided into three groups A, B and C on the basis of randomization
 performed using an envelope technique. The participants in group A will perform PNF D2 with
 free weights (PNF D2 FW), participants of Group B will perform PNF D2 with elastic bands (PNF
 D2 ERB) while Group C will be control group and the participants of this group will perform
 PNF D2 without resistance (PNF D2 WR). Initially, consent will be obtained from all
 participants after explaining them the protocols of treatment. The Pulmonary Function Test
 (PFT) will be performed to record pre-intervention spirometric values of FEV1/FVC
 (Tiffeneau-Pinelli Index), Minute Ventilation (MV), Force expiratory volume in 1 second
 (FEV1), Forced Vital capacity (FVC), Total Lung Capacity (TLC) and Residual Volume (RV).
 Similarly, 6 Minute Walk Test (6MWT) and St. George's Respiratory Questionnaire Score will be
 recorded to determine the exercise capacity and health status score of COPD patient
 respectively. Following the assessment procedure, both groups will receive 8 weeks of
 treatment with frequency of 3 sessions per week lasting for 30 minutes approximately.

 Intervention Protocol Group A Participants in Group A will perform PNF D2 flexion and
 extension with free weights (PNF D2 FW) The intensity of exercise will be determined for each
 individual by using maximum repetition test (1 repetition maximum 1-RM). The intensity will
 be kept 50 % of the maximal load. 3 sets of PNF D2 FW Flexion (flexion-abduction and external
 rotation) and PNF D2 FW Extension (extension-adduction-internal rotation) respectively will
 be performed on each upper limb with 10 repetitions per set. All exercises will be performed
 with a rest interval of 30 seconds to 1 minute between the sets.

 Intervention Protocol Group B Participants in this group will perform 3 sets of PNF D2
 flexion (flexion-abduction and external rotation) and extension (extension-adduction-internal
 rotation) respectively with elastic bands after assessing the 1-RM test starting with a
 lightest resistance and gradually progressing to the higher level. Subsequently, 71% to 86%
 of 1-RM will be taken as a target range of the resistance for the training . Moreover, each
 set will consist of 10 repetitions for both D2 flexion and Extension and a resting interval
 of 60 seconds between two consecutive sets. The procedure will be repeated for both limbs.

 Intervention Protocol Group C The participants in the Group C or control group will perform
 the PNF D2 flexion and extension without any resistance. Three sets consist of 10 repetitions
 of each pattern for both upper limbs will be performed with an interval of 60 seconds between
 two consecutive sets.

 After 8 weeks of training, the pulmonary function test (PFT), 6 Minute Walk Test and George's
 Respiratory Questionnaire scores will be recorded for post intervention readings. Results
 will be recorded and statistical analysis will be performed.
Inclusion Criteria:

 -  Diagnosed COPD patients of Age 40 and above (Razzaq et al., 2018)

 -  COPD grade 2 and 3 according to GOLD classification (Berry et al., 2018)
 (Goldcopd.org, 2019)

 -  COPD patient both male and female

 Exclusion Criteria:

 -  Individuals with either fractures of ribs or upper limb

 -  Pulmonary Effusion,

 -  Pulmonary Edema,

 -  Embolism,

 -  Pneumothorax

 -  Hemothorax