PROFORMA FOR REGISTRATION OF



PROFORMA FOR REGISTRATION OF SUBJECTS

FOR DISSERTATION

DISSERTATION PROPOSAL

Topic:-

“A STUDY ON EFFICACY OF UPPER BODY RESISTANCE TRAINING ON IMPROVING PULMONARY FUNCTION & FUNCTIONAL CAPACITY AMONG SEDENTARY MALE SMOKERS”.

Experimental Study

SUBMITTED BY

ASWINI. J

1 YEAR MPT (2010-11 BATCH)

SHRIDEVI COLLEGE OF PHYSIOTHERAPY

TUMKUR-572106.

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE

ANNEXURE – II

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

|1. |NAME OF THE CANDIDATE AND ADDRESS |ASWINI. J |

| | |MPT 1ST YEAR |

| | |SHRIDEVI COLLEGE OF PHYSIOTHERAPY |

| | |LINGAPURA, SIRA ROAD, TUMKUR-572106. |

|2. |NAME OF THE INSTITUTION |SHRIDEVI COLLEGE OF PHYSIOTHERAPY |

|3. |COURSE OF THE STUDY |1ST YEAR MPT (CARDIO RESPIRATORY & INTENSIVE CARE) |

|4. |DATE OF ADMISSION TO COURSE |18-05-2010 |

| | | |

|5. |TITLE OF THE STUDY |“ A STUDY ON EFFICACY OF UPPER BODY RESISTANCE TRAINING ON |

| | |IMPROVING PULMONARY FUNCTION AND FUNCTIONAL CAPACITY AMONG |

| | |SEDENTARY MALE SMOKERS”. |

| | |Experimental Study. |

6. Brief Resume of Intended Work

Introduction:

The Respiratory system is very much crucial to every human being. Without it, we would cease to live outside of the womb. The Respiratory System is vital to human life. 1

The organs of the Respiratory System make sure that Oxygen enters our bodies and Co2 leaves our bodies. This structurally, the Respiratory System consists of two portions: (1) The upper respiratory system which includes the nose, pharynx and associated structures and (2) The lower respiratory system which includes the larynx, bronchi and lungs. This integrated system of organs involved in the intake and exchange of O2 & Co2 between an organism and environment. As air moves along the respiratory trait, it is warmed, moistened and filtered.2

Smoking and air pollution are two common causes of respiratory problems. Smoking causes fatal diseases to develop in many parts of the body including cancers of upper and lower respiratory tracts.3

In Western countries smoking is the major risk factor for the diseases which can affect the functional capacity and pulmonary function of the subjects. According to the study of male British Doctors between 1951 and 1991, smoking caused 81% of diseases related to Respiratory System and 78% of deaths from Chronic Obstructive Pulmonary Disorder. 4

Smoking causes an irreparable damage to the respiratory system hence reducing the fitness level, functional capacity and pulmonary function. Smoking does have a negative effects of body building and fitness also. In case of sedentary smokers, smoking strongly affects the performance level as it destroys the body cells including muscle cells. 5

A variety of Therapies have been advocated for the improvement of pulmonary function, functional capacity, body building, fitness in these types of sedentary male smokers, including Breathing exercises, Herbal remedies, Relaxation therapies, Homeopathy, Pharmacology, Pranayama, Accupuncture etc. 6

However, the recent studies shown that there is a significant changes in the functional outcome, pulmonary function, endurance and body strength due to the specific training like upper body resistance training.

Following upper body resistance training, respiratory muscle strength increased, subjective improvement in ability to perform activities of daily living using upper extremities, and also maximizes the training effects, minimizes fatigue, and maximizes the lung compliance. 7

6.1. Need of the study

Breathing is very important and essential in our human life for two major reasons. It is the only means of supply our bodies and it` s various organs with the supply of O2 which is vital for our survival. The second function of breathing is that it is one means to get rid of waste products and toxins from the body. 8

Oxygen is the most vital nutrient for our bodies. It is very essential for the integrity of the brain, nerves, glands and integral organs. We can do without for weeks and without water for days but without O2 , we will die within a few minutes. Poor oxygen supply affects all parts of the body.9

Smoking severely affects our respiratory system. It causes many Lung diseases like emphysema, bronchitis, chronic airway obstruction by damaging the airways and alveoli of the Lungs. 10

Smoking stops the small little hairs in throat from working as well these small little hairs are called cilia and are used to push dirt and mucous out of your throat. 11

To play or to do any other form of activities like Activities of Daily Living and other strenuous activities, it needs large amounts of energy. Our body is like an engine and it needs fuel to work. The Lungs provide fuel in the form of oxygen. Then the blood transports this fuel to the muscles that burn it during physical activity. 12

Smoking affects the lungs, so that they work less effectively. They can’t pick up the amount of O2 that body needs when it is working hard. Due to tobacco smoke out body will have less fuel and it has not transported to those areas that need it when performing activities. Because of this, smokers tend to have less energy and find it hard to keep high levels of fitness. 13

There are various physical therapy interventions and exercises that can improve the exchange of gases in the lungs and therefore improve Lung function. Exercises of any kind will overtime improve your Lung capacity. This is because exercise forces the chest to make extensive inhalations and exhalations. As a result, there are constantly repeated diaphragmatic and ribcage movements and the maximum lung capacity gradually increases. 14

The effects and benefits of various methods of breathing exercises, pranayama, and pharmacology on improving pulmonary function are well documented. But very less literature exists to show the effects of resistance training especially Upper Body Resistance training on improving pulmonary function, functional capacity on healthy male smokers.

Thus this study is very much required to document the effects of upper body resistance function on pulmonary function and also aimed to plan the suitable intervention programme for improvement of pulmonary function & functional capacity among smokers. This could prevent the functional disability of the smokers and decrease the health care costs in the smoking population.

6.2. OBJECTIVE OF THE STUDY

1. To find the efficacy of Upper Body Resistance Training on improving pulmonary function and functional capacity among sedentary male smokers.

2. To find out the efficacy of conventional breathing exercises, on improving pulmonary function and functional capacity among sedentary male smokers.

3. To compare the efficacy of Upper Body Resistance Training and breathing exercises on improving pulmonary function and functional capacity among sedentary male smokers.

4. To establish that the Upper Body Resistance Training as an important intervention to improve the pulmonary function and functional capacity among sedentary male smokers.

6.3. Hypothesis

1. Null Hypothesis

Upper Body Resistance Training doesn` t yield significant changes on pulmonary functions and functional capacity while compared to conventional breathing exercises among sedentary male smokers.

2. Alternative Hypothesis

Upper Body Resistance Training yield significant changes on pulmonary functions and functional capacity while compared to conventional breathing exercises among sedentary male smokers.

4. Review of Literature

1. Peto. R etal

Of all inhalations exposures cigarette smoking is the primary risk factor in most countries, al though only about 15% of smokers develop clinically apparent COPD. Others may affected with functional disability, reduced pulmonary functions and exercise intolerance.

2. Hatsukami et al

Sedentary smokers often have exercise intolerance as their chief complaint. In recent years, it has become clear that dysfunction of muscles of ambulation contributes to exercise intolerance in these subjects.16

3. A. Daley et al

When a tobacco leaf is burnt, the smoker is exposed to over 4000 chemicals. The number of the substances found in tobacco smoke are known human carcinogens. Cigarette smoking has a harmful effect on the lung capacity of the peoples which is demonstrated by impaired Lung function tests. 17

4. Nunn et al

Spirometry is the recommended way of assessing air flow limitation. The smokers will have a reduced FEV1 and Fev1 / FVC ratio. FEV1 is the forced expiratory volume in one second and FVC is forced vital capacity. Cigarette smoking has a harmful effect on the lung capacity of people which is demonstrated by impaired Lung function tests. 18

5. Borth. F.M. et al

Spirometry is the most basic test of pulmonary function. Spirometry is most often used to diagnose and monitor lung problems. Spirometry is also used to monitor how well medicines for respiratory problems are working. This is the accurate method to assess the pulmonary function. 19

6. Gupta. D et al

The most common parameters measured in spirometry are vital capacity (VC), forced vital capacity (FVC), forced expiratory volume at time intervals of 1 (FEV1). Other tests may be performed in certain situations. 20

7. Mark Kosak et al

The study aimed to assess the inter and intracter reliability and sensitivity to change of the 2-, 6- and 12- minutes walk tests on functional capacity among smokers, shows the all three tests show acceptable inter – and intracter reliability and high interest correlations when they used for the assessment. But the SRM statistic indicates that the 12- minutes walk test is the most responsive to change. 21

8. D.P. Tashkin et al

Resistance training may be useful addition to aerobic programs for smokers. The purpose of the study aimed to investigate the effects of Upper Body Resistance Training on functional outcomes in pts with COPD. 17 subjects were selected and given resistance training for 12 wks. The study demonstrated that the 6 of 8 tasks of ADL were improved and also the 12 min-walk distance increased.

9. A.M. Li et al

The study aimed to assess the validity and reliability of 12 min. walk test, healthy male subjects were randomly recruited, repeated spirometry and 12 minutes walk test were carried out for 2 weeks. Test-Retest reliability was undertaken in 52 subjects, and the interclass correlation coefficient was calculated. The results show that the 12 minutes walk test is a reliable and valid functional test for assessing pulmonary function & endurance. 23

10. Shaw et al

In order to document the effects of upper body resistance training Upper Body Resistance Training on spirometry values, 36 sedentary but healthy male smokers (mean age : 33 years) were selected and assigned into control (n=18) and experimental groups (n=18). The experimental group were assigned to Upper Body Resistance Training programme for 8 wks. duration. Significant changes were found in FVC, FEV1, FEV1 / FVC ratio in experimental group. The investigation concluded that Upper Body Resistance Training is sufficient to change the pulmonary function variables in sedentary male smokers. 24

11. Jose Maria et al

To evaluate the effect of utilization of specific Upper Body Resistance Training programme on pulmonary function in tobacco smokers, 50 asymptomatic tobacco smokers with age of > 30 yrs., were studied for 3 wks. duration. The results shows that the application of Upper Body Resistance Training produced immediate improvement in the performance of respiratory muscles based on FVC, FEV1 , MVV. 25

12. Wade. A et al

Upper Body Resistance Training specially impacts the arms and has been shown to increase arm work capacity while decreasing VO2 for a comparable work level. They helps to desensitize the dysphea, better coordination of muscles and to adopt the exercises. Thus the arm exercise are safe, and should be included in the rehabilitation programmes for patients with Lung diseases. 26

7. Materials & methodology

1. Sources of data

• Shridevi Hospital, Tumkur.

• Govt. Dist. Hospital, Tumkur.

2. Method of collection of data.

1. Sample Design: The samples are selected by using simple random sampling technique.

2. Study Design: Experimental study with pre-test and post test design.

3. Sample Size : The sample size consists of 40 healthy sedentary male smokers. They were selected randomly and assigned in to 2 groups.

➢ Experimental Group: Consists of 20 healthy sedentary male smokers to be given selected Upper Body Resistance Training for 8 wks duration.

➢ Control Group: Consists of 20 healthy sedentary male smokers to be given conventional breathing exercises for 8 wks, duration.

3. Selection Criteria:

o Inclusion Criteria

• Healthy sedentary male smokers

• Age between 30 – 50

• Subjects with minimum 10 pack years.

• Cooperative subjects.

o Excluding Criteria

• Subjects with diagnosed lung diseases (COPD, Lung Cancer etc.).

• Age less than 30 yrs., and more than 50 yrs.

• Female subjects

• Subjects with < 10 pack years.

• Subjects with recent history of surgeries, recent history fractures.

• Unwilling subjects, Non-cooperative subjects.

• Subjects with mental disorders.

• Subjects with unstable medical condition.

4. Duration of the study:

8 wks duration for each subjects in both groups.

5. Measurement Tools

• Spirometary

• 12 minute walk test

7.6. Procedure:

After checking the inclusion and exclusion criteria, 40 healthy sedentary male smokers to be selected randomly and assigned into 2 groups with 20 subjects each. The experimental group consists of 20 sedentary male smokers to be given Upper Body Resistance Training (UBRT) for 8 wks. during. The control group subjects to be given conventional breathing exercises.

After getting informed consent a brief introduction about the aim of the study and treatment procedures to be explained to all participants of the study. Before starting the treatment procedure, both the groups t be evaluated for pulmonary function and functional capacity by means of spirometary and 12 minute walk test.

I. Treatment procedure for experimental group:

Upper Body Resistance Training (UBRT)

Shoulder Press:

Starting position – Sit on a stool either facing or with your back to the shoulder press unit depending on the design. Select the required weight and adjust the height of the seat to that the shoulder bar rests just above shoulder level. Place your hands on the grips and keep your back straight and feet on the floor.

Movement – Slowly move the bar up in a controlled manner whilst exhaling pause at the end of your range making sure your elbows are fully extended. Then return the bar to the starting position in a controlled manner while exhaling. Try to keep your back straight at all times.

Bench Press:

Starting position – Select the required weight, Lie with your back on the bench with your knees apart and feet flat on the floor and with your head, shoulders and buttocks in contact with the bench. The bar should be level with your breastbone. Grip the bar.

Movement – Slowly press the bar towards the ceiling whilst exhaling pause at your end of range and slowly lower the bar to the starting position whilst inhaling. Keep your hips in contact with the bench.

Aim – To develop muscles of the chest, shoulders and upper arm.

Chest Press:

Wrap the band around something stable behind you and hold handles in both hands, tubing running along the inside of the arms (under the armpits), palms facing each other. Squeeze chest and press arms out in front of you. Return to start and repeat.

Overhead Press:

Place both feet on tube and grasp handles, bringing hands up just over shoulders with elbows bent and palms in. press arms up over head and then lower.

Rear Delt Row:

Wrap band around stable object and sit (or stand) facing it, holding the handles with arms out in front, palms own. Pull the elbows back until level with torso, squeezing the shoulder blades and keeping arms parallel to ground.

Subjects performed 3 sets of each exercise per session.

First 4 weeks : The training target was 3 sets of 12 repitition at 60% of pre training one-repitition max. Intensity was increased when subjects completed all 36 repititions of a given exercise, when 3 sets of 12 repititions were again achieved loads were increased.

After 4 weeks of training, one repitative max values were reassessed and used for retraining 4 weeks.

Subjects performed 4 sets of 8-10 repitations, using 80% of the new one repitation max for each training exercise. The intensity was subsequently advanced as tolerated.

II. Treatment procedure for control group

Conventional breathing exercise include:

a) Abdominal breathing

Position of the patient: Supine lying

Ask the patient to keep both the hands on the abdomen slowly inhale the air from the nose and exhale through the nose slowly. See the movement of the abdomen up and down.

b) Diaphragmatic Breathing

Position of the patient: Relaxed and comfortable position such as semi Fowlers position (reclined sitting).

Ask the patient to keep both the hands on the rectus abdominis just below the anterior costal margin.

Ask the patient to breathe in slowly and deeply through the nose. Have the patient keep the shoulder relaxed and upper chest quiet allowing the abdomen to rise. Have the patient to practice 3 or 4 times and then rest. Do not allow the patient to hyper ventilate.

c) Pursed Lip Breathing:

Position of the patient : Comfortable and relaxed position.

Explain the patient that expiration must be relaxed and that contraction of the abdominals must be avoided.

Ask the patient to keep both the hands on the abdominal and to detect any contraction of abdominal. Instruct the patient to breathe in slowly and deeply. Than have the patient loosely pursed the lip and exhale.

Statistical Test:

Statistical test to be used for data analysis are

• Mean

• Standard Deviation

• Parametric & Non-parametric tests.

7. Does the study require any investigation to be conducted on patient or other human or animals / If so please describe briefly.

Yes, This study require interventions like conventional breathing exercises, Upper Body Resistance Training to be given to the sedentary male smokers.

8. Ethical Clearance:

The study will be conducted after the approval of research committee of the college. Permission will be obtained from the head of the Institution. The purpose and detail of the study will be explained to the study subject and assurance will be given regarding confidentially of the data collected.

7. List of References:

1. Mader, Sylvia. G. Human Biology Mc. Graw Hill Publishing, Burr Ridge 1L-2004.

2. C. Everet Koop, “The respiratory system” British. J – Chest disease Vol. 5, Issue 22 (20) 2008.

3. Mc Namara PS, Smith RL, “The Pathogenesis of Respiratory Diseases”, Br. Med Bull. 2002, 61:13-28.

4. Gross MF, Spear RM “ Ventilation”, Crit Care 2000; 4:188-192.

5. martin CJ, Marc Van Herde, “Respiratory System”, Department of Intensive Care, V.U. University; R.L. Netherland; 12 Dec 2008, 13 (3): R 71.

6. Jennifer A, Rucord S; “Physical Therapy for Respiratory and connective problems – Adults AM. J. Chest diseases – Vol. 25, Issue-4;P (215-324) (2001).

7. Prior A, Prasad M; “Role of Physical Therapy in the management of Lung disorders – Systematic Review”; Vol. 101, Issue-12, P (2429-2436); (2007).

8. Hammer. J, Numa. A; Respiration – An Overview”; J. Paedia 1995 ; 147:485-490.

9. Paolo Pelosi, Walter A ; Respiratory system and artificial ventilation”: A.J. Chest medicine ; Vol. 4; 25(4) : 2009.

10. Peto R, Boreham J; Smoking, smoking cessation and Lung cancer – 1950; Combination of national statistics; British Journal 2000; 321 (2757): 323-329.

11. Braun. L, Herbs C; “Respiratory Tract Infection: An evidence based grade, Wikipedia. P (205); 2006.

12. Y.A. Patel, P. Patel, H. Pavadia Department of Tuberculosis and Respiratory Disease, Govt. medical College, Bhavnagar, Vol. 56, Issue-4; Pages 27-34 (2010).

13. Collins Rs, Cotron Rs; Robbins J; ”Pathological basis of disease” – B.J. Crit. Care; Issue-4, Vol.2, P-275-284 (2001).

14. Josely. R, Don. S – “Pulmonary Rehabilitation”, Joint ACCP / AA CVPR evidence – based guidelines; Upper extremity training : 1994-2010. webMDLLC.

15. Peto. R, Tarun Madappa MD; “Physiotherapy for Airway Clearance in Adults” ; L.J. Intensive Care, Vol.4; Issue – 1; P (115-125) (1989).

16. Hatsukami DK, Stead LF; Tobacco Addiction. Lancet 2008; 371 (96-Pubmed).

17. Daley. A, Begh R; Influence of smoking : Systematic Review of observational studies ; British Medical Journal 2010; 340.

18. Nunn A J, I. Gregg, New Regression equations for predicting peak Expiratory flow in adults. Br. Med. J 298: 1068 – 1070 (1989).

19. Broth. F.M ; “The deviation of an index of ventilatary function from spirometric recording using canonical analysis”. British. J of chest disease; 76:400-756 (1982).

20. Gupta. D, Marsh. J, Role of Conventional Physiotherapy in Respiratory disorder; Art 116; 287-309 (1995).

21. Marc Kosak MSPT, Teresa Smith MSPT, Burke Rehabilitation Hospital, white plains, NY; “Comparison of the 2-, 6- and 12 minute walk tests in pulmonary function”. J. Rehab; Vol.42, No.1, P-103-108 (2005).

22. D.P. Tashkin, Department of Medicine, School of medicine, UCLA, 10833, Las Angles, CA, 90095-1690, USA; “Effects of Resistance Training in Pulmonary function”. Vol. 4, Issue-5, 27-54 (2007).

23. A.M.Li, Cobb C, Ward KD; “Emerging Health Crisis in the United States”. AM. J. Health. Vol. I; Issue-1; P (78-121) (1990).

24. Shaw, Ina; Pulmonary function Tests – Effects of Upper Body Resistance Training on pulmonary function in sedentary male smokers, Abstract : 27 Oct 2008; 2003-10.

25. Jose Maria, Cateno Antony; g8- Aeta Cirmgica Brasiteria – Vol. 22(2). 2007.

26. Wade A, Stricks J; “Reference ranges for spirometry across all ages”; AM J. Respiratory Critical Care Med: 177(3): 293-60. (Feb 2008).

|9. |Signature of the Candidate | |

|10. |Remarks of the Guide | |

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|11. |Name and Designation of | |

| |(in block letters) | |

| |11.1. Guide | |

| |Signature | |

| |Co-guide (if any) | |

| |Signature | |

| |Head of the Department | |

| |Signature | |

|12. |12.1. Remarks of the Chairman and Principal. | |

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| | | |

| | | |

| | | |

| |12.2. Signature | |

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