None listed
Conditions
Brief summary
Ageing is associated with a range of anatomical and physiological changes that include the respiratory system. These changes begin as early as 40 years of age and include stiffening of the spine and chest wall. This stiffening has an impact on breathing mechanics and is a cause of the progressive decline in lung function typically associated with ageing. The aim of this trial is to investigate whether reducing stiffness in the spine and chest wall improves lung function in people over 50 years of age. The trial is designed as a randomised controlled trial with 306 healthy people between the ages of 50 and 65 years randomly allocated to one of three equal groups. Group 1 (Control) will receive a standardised exercise program performed on a treadmill. Group 2 will receive a mobilisation protocol designed to increase joint mobility in the thoracic spine and ribs followed by the same exercise program. Group 3 will receive a manipulation protocol designed to increase joint mobility in the thoracic spine and ribs followed by the same exercise program. Each participant will receive six intervention sessions over a period of three weeks. Outcome measurements will be taken by assessors who are unaware of the group a participant has been allocated to. They include non-invasive lung function measurements, chest expansion and a respiratory function questionnaire. These measurements will be taken on four occasions: before the first intervention (baseline), at the end of the intervention period (3 weeks), and then at 3 and 6 weeks post-intervention (i.e. in the 6th and 9th weeks of the trial). The last two measuring points are designed to assess whether the effects of intervention are ongoing. Lung function will be measured using spirometry (exhaling into a tube) and chest expansion measured using a tape measure. It is expected that manual therapy plus exercise will improve lung function more than exercise alone. It is also expected that improvements in lung function will be different for the two manual therapy interventions.
Interventions
Intervention groups:
Group 1: Exercise
Group 2: Thoracic mobilisation + exercise
Group 3: Thoracic manipulation + exercise
Exercise will involve a standardised 10 minute treadmill walking program at a speed and inclination that is considered 'comfortable' for the participant.
Thoracic mobilisation will involve soft tissue therapy followed by a joint mobilisation protocol administered to the muscles of the posterior chest wall and the thoracic spine T2-T12), costo-vertebral and costo-transvers
Intervention groups: Group 1: Exercise Group 2: Thoracic mobilisation + exercise Group 3: Thoracic manipulation + exercise Exercise will involve a standardised 10 minute treadmill walking program at a speed and inclination that is considered 'comfortable' for the participant. Thoracic mobilisation will involve soft tissue therapy followed by a joint mobilisation protocol administered to the muscles of the posterior chest wall and the thoracic spine T2-T12), costo-vertebral and costo-transverse joints (2nd-10th) respectively. This protocol will include 5 minutes of soft tissue therapy to the muscles of the posterior chest wall followed by 5 repetitions of joint mobilisation (Maitland Grades III-IV) in each of the following 4 directions: flexion/extension, left and right rotation, left and right transverse, and left and right ribs. The total time for a mobilisation session is 15 minutes. Thoracic manipulation will involve soft tissue therapy followed by a joint manipulation protocol administered to the muscles of the posterior chest wall and the thoracic spine T2-T12), costo-vertebral and costo-transverse joints (2nd-10th) respectively. This protocol will include 5 minutes of soft tissue therapy to the muscles of the posterior chest wall followed by 2 manipulations (Maitland Grade V) administered to the upper/middle and middle/lower thoracic spine and ribs. Each manipulation will be administered as a 'group' manipulation that involves multiple thoracic inter-vertebral, cost-vertebral and costo-transverse joints The total time for a mobilisation session is 15 minutes. A register of attendance at the intervention sessions (exercise, mobilisation and manipulation) will be kept for each participant. Masters of Osteopathy interns will deliver mobilisation and manipulation intervention. Master of Clinical Exercise Physiology interns will supervise exercise performance. All three interventions will be administered 6 times over a 3 week period @ 2 times per week. The trial will be conducted in Southern Cross University's Lismore and Gold Coast Health Clinics.
Sponsors
Southern Cross University
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Prevention
Masking
Blinded (masking used) (Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
All
Age
50 Years to 65 Years
Healthy volunteers
Yes
Inclusion criteria
i. No history of respiratory disease ii. Currently non-smoking (preceding 6 months) iii. Able to walk unaided and unassisted on a treadmill for 10 minutes
Exclusion criteria
i. Inability to walk unaided and unassisted on a treadmill ii. Contra-indication to thoracic manual therapy (mobilisation/manipulation) Osteoporosis Thoracic joint instability Acute pain on thoracic joint range of motion testing Below normal chest wall musculature for age and gender High level of anxiety related to receiving thoracic spinal mobilisation or manipulation iii. Inability to understand English iv. People with a cognitive impairment, an intellectual disability or a mental illness
Outcome results
None listed