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    Effects of adding respiratory training to osteopathic manipulative treatment on exhaled nitric oxide level and cardiopulmonary function in patients with pulmonary arterial hypertension
    (Elsevier, 2022) Baha, Naci; Demir, Rengin; Sinan, Ümit Yaşar; Küçükoğlu, Mehmet Serdar; Önder, Ömer Önder
    Limited research exists regarding nonpharmacologic management of pulmonary arterial hypertension (PAH), except for exercise training. The objective of this study was to investigate the effects of osteopathic manipulative treatment (OMT) alone and combined with respiratory training on fractional exhaled nitric oxide (FeNO), and cardiopulmonary function in patients with PAH. This single-blind, prospective, randomized controlled study included 54 patients with PAH who were randomly allocated to OMT, combined intervention, and control groups. The OMT group (n = 16) and combined intervention group (n = 16) received OMT and yoga respiratory training plus OMT, respectively, twice a week for 8 weeks. The control group (n = 16) received no intervention. All patients undertook an educational lecture. FeNO level, pulmonary function, 6-minute walk distance (6MWD), maximal inspiratory and expiratory pressures, and handgrip strength were assessed at baseline and 8 weeks. Combined intervention and OMT groups significantly improved all outcome measures after 8 weeks of treatment (p <0.01), except mean forced expiratory flow between 25% and 75% of forced vital capacity, which did not change in the OMT group (p >0.05). The control group showed significant deteriorations in 6MWD, inspiratory and peripheral muscle strength, and pulmonary function except peak expiratory flow at 8 weeks (p <0.05). The combined intervention group revealed significantly greater improvements of FeNO, 6MWD, respiratory and peripheral muscle strength, and pulmonary function except mean forced expiratory flow between 25% and 75% of forced vital capacity compared with the OMT group (p <0.05). All outcomes significantly improved in both intervention groups versus the control group (p <0.05). Our study demonstrated that adding respiratory training to OMT provided further benefit to FeNO level and cardiopulmonary function compared with OMT alone and that the OMT might be a useful and safe intervention for patients who cannot attend cardiac rehabilitation programs.
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    Effects of osteopathic manipulative treatment alone or in combination with respiratory training on chest wall expansion, functional mobility, and dyspnea level in patients with pulmonary arterial hypertension
    (American Thoracic Society, 2024) Naci, Baha; Demir, Rengin; Önder, Ömer Önder; Sinan, Ümit Yaşar; Küçükoğlu, Mehmet Serdar
    RATIONALE: While exercise training has been extensively investigated for nonpharmacologic treatment of pulmonary arterialhypertension (PAH), osteopathic manipulative treatment (OMT) has not been adequately examined. The purpose of this study wasto explore the efficacy of OMT alone or in association with respiratory training on chest wall expansion, functional mobility, anddyspnea level in patients with PAH. METHODS: 48 patients under PAH-targeted medical therapy for at least 3 months, betweenthe ages 20-74 (mean [SD] age: 48.4 [12.1] years) and with the World Health Organization functional class I to III were involved inthe study. Chest wall expansion was evaluated with a cloth tape measure at maximal inhalation and exhalation at 3 levels of the ribcage (axillary line, xiphoid process, lateral lower edge of the tenth costae) by subtracting the end-expiratory diameter from theend-inspiratory diameter. Functional mobility was assessed using 5-repetition sit-to-stand test. Dyspnea level was determinedwith the modified Medical Research Council scale. Patients were divided into OMT, combined intervention, and control groups,with 18 patients in each group. Rib raising, diaphragm release, suboccipital decompression, first rib mobilization, mediastinummobilization and thoracic inlet myofascial release techniques were applied to the OMT group twice weekly for 8 weeks. In additionto OMT, a yoga respiratory training session including nadishodhana, ujjayi, and bhramari pranayama was undertaken by thecombined intervention group. The breathing exercises were also performed once daily for the remaining days as home exercises.Control group received no additional intervention. All patients received an educational lecture. For between-group comparisonsand within-group differences of baseline with 8 weeks, one-way ANOVA with between-subject factor and the paired samples t testwere used, respectively. Pairwise multiple comparisons were conducted using Bonferroni post hoc tests.RESULTS: All outcomemeasures improved significantly in both intervention groups (p<0.01), whereas the control group showed no significant difference(p>0.05). Improvements for functional mobility and all the chest wall expansion data were significantly higher in combinedintervention group than other groups, and also in OMT group than control group (p<0.05) (Table 1). Improvement for dyspnea levelwas significantly higher in both intervention groups compared with the control group (p<0.05) (Table 1). CONCLUSION: This studydemonstrated that the addition of respiratory training to OMT revealed further benefit to chest wall expansion and functionalmobility compared to OMT alone and that the OMT might be an effective therapeutic method for dyspneic patients havingdifficulties in participating cardiopulmonary rehabilitation programs.