Effects of Proprioceptive Neuromuscular Facilitation Stretching Combined with Aerobic Training on Pulmonary Function in COPD Patients: A Randomized Controlled Trial

Figures & data

Table 1 Stretching Methods for Different Muscles

Muscles	Patient Posture	Therapist Techniques
Pectoralis major, pectoralis minor	Sitting decubitus, 90° shoulder abduction with external rotation, elbow flexion	One hand fixes the sternum, and another hand horizontally abducts the affected shoulder
Upper trapezius	Supine decubitus, neck contralateral rotation and contralateral flexion	One hand presses the affected shoulder, and another hand anteriorly flexes the neck
Scalenus	Supine decubitus, neck lateral flexion	One hand presses the affected shoulder, and another hand assists neck lateral flexion
Sternocleidomastoid	Supine decubitus, neck ipsilateral rotation and contralateral flexion	One hand fixes the collar bone, and another hand posteriorly protracts the neck
Intercostals and anterior serratus	Lateral decubitus, shoulder abduction	One hand abducts the shoulder, and another hand draws down the ribs
Abdominal	Prone decubitus, both hands on the stretcher, head and upper body lean back	Assist patients to lean back

Table 2 Baseline Characteristics of the Study Patients

Characteristics	Control Group (n = 27)	PNF Group (n = 28)	P value
Age (y)	67.96±1.70	68.14±1.65	0.692
Gender (male/female)	22/5	22/6	0.787
BMI (kg/m^2)	28.00±1.69	27.10±2.64	0.139
CAT score	20.15±1.35	20.29±1.24	0.696
Dyspnea VAS score	5.88±0.91	6.12±1.03	0.365
FVC% predicted (%)	67.88±1.11	68.18±1.27	0.355
FEV1% predicted (%)	47.41±1.13	47.29±1.53	0.732
IC (mL)	1786.85±54.35	1772.39±58.56	0.347
IRV (mL)	1257.78±18.88	1265.36±17.10	0.124
6MWT (m)	300.41±6.35	297.50±7.49	0.127
Head protraction ROM (°)	9.37±1.88	9.04±2.15	0.543
Maximum head protraction (°)	13.04±1.16	13.46±1.43	0.229
Maximum head retraction (°)	22.41±1.87	22.50±2.05	0.862
Shoulder flexion ROM (°)	149.81±8.93	153.21±9.35	0.174
PmM length (cm)	15.48±0.54	15.34±0.53	0.343
GOLD stage (II/III)	20/7	21/7	0.937

Note: Data are presented as mean ± standard deviation or absolute number.

Abbreviations: PNF, proprioceptive neuromuscular facilitation; BMI, body mass index; CAT, COPD Assessment Test; VAS, Visual Analogue Scale; FVC, forced vital capacity; FEV₁, forced expiratory volume in the first second; IC, inspiratory capacity; IRV, inspiratory reserve volume; 6MWT, 6-minute walk test; ROM, range of motion; PmM, pectoralis minor muscle; GOLD, Global Initiative for Chronic Obstructive Lung Disease.

Figure 1 Study flow diagram.

Abbreviations: FEV₁, forced expiratory volume in the first second; PNF, proprioceptive neuromuscular facilitation; GOLD, Global Initiative for Chronic Obstructive Pulmonary Disease.

Figure 2 Comparison of respiratory symptoms, pulmonary function and muscular movement before and after rehabilitation training in different groups. (A) CAT score; (B) dyspnea VAS score; (C) FVC% predicted; (D) FEV₁% predicted; (E) IC; (F) IRV; (G) 6MWT; (H) head protraction ROM; (I) maximum head protraction; (J) maximum head retraction; (K) shoulder flexion ROM; (L) PmM length. *P < 0.05, ***P < 0.001.

Abbreviations: PNF, proprioceptive neuromuscular facilitation; BMI, body mass index; CAT, COPD Assessment Test; VAS, Visual Analogue Scale; FVC, forced vital capacity; FEV₁, forced expiratory volume in the first second; IC, inspiratory capacity; IRV, inspiratory reserve volume; 6MWT, 6-minute walking distance test; ROM, range of motion.

Figure 3 Correlation between neck/shoulder mobility and lung function in the PNF group. (A) Head protraction ROM and IC; (B) PmM length and IC; (C) shoulder flexion ROM and IRV.

Abbreviations: PNF, proprioceptive neuromuscular facilitation; ROM, range of motion; IC, inspiratory capacity; IRV, inspiratory reserve volume; PmM, pectoralis minor muscle.