The Long-term benefit of exercise with and without manual therapy for mild chronic obstructive pulmonary disease: a randomized controlled trial

Purpose: Chronic obstructive pulmonary disease (COPD) is characterized by decreasing exercise capacity and deteriorating quality of life (QoL). Recent evidence indicates that combining exercise with manual therapy (MT) delivers greater improvements in exercise capacity than exercise alone in moderate COPD. The aim of this study was to investigate whether this combination delivers similar results in mild COPD. Methods: A total of 71 participants aged 50-65 yr with mild COPD were randomly allocated to two groups: exercise only (Ex) or MT plus exercise (MT + Ex). Both groups received 16 wk of exercise with the MT + Ex group also receiving 8 MT sessions. Lung function (forced vital capacity [FVC] and forced expiratory volume in the 1^st sec [FEV₁]), exercise capacity (6-min walk test [6MWT]), and QoL (St George’s Respiratory Questionnaire [SGRQ] and Hospital Anxiety and Depression Scale [HADS]) were measured at baseline, 4, 8, 16, 24, 32, and 48 wk. Results: Although there was no difference in the mean effect over time between groups for lung function (FEV₁, P = .97; FVC, P = .98), exercise capacity (6MWT, P = .98), and QoL (SGRQ, P = .41; HADS anxiety, P = .52; and HADS depression, P = .06), there were clinically meaningful improvements at 48 wk for 6MWT (30 m; 95% CI, 10-51 m; P < .001), SGRQ (6.3 units; 95% CI, 2.5-10.0; P < .001), and HADS anxiety (1.5 units; 95% CI, 0.3-2.8 units; P = .006) across the entire cohort. Conclusions: While adding MT to Ex did not produce any additional benefits, exercise alone did deliver sustained modest improvements in exercise capacity and QoL in mild COPD.