Effect of Thoracic Mobilization in People With Central Obesity

Effect of Mulligan Thoracic Mobilization on Ventilatory Functions and Chest Wall Expansion in Central Obesity

The goal of this clinical trial is to learn whether Mulligan thoracic mobilization in extension improves ventilatory functions and chest wall expansion in adults with central obesity. It will also evaluate whether adding Mulligan thoracic mobilization to a low-carbohydrate diet and aerobic exercise provides greater benefits than diet and exercise alone.

The main questions it aims to answer are:

Does Mulligan thoracic mobilization improve ventilatory functions (FVC, FEV₁, FEV₁/FVC ratio, and MVV) in adults with central obesity? Does Mulligan thoracic mobilization improve chest wall expansion, functional capacity, and health-related quality of life?

Researchers will compare Mulligan thoracic mobilization combined with a low-carbohydrate diet and aerobic exercise to a low-carbohydrate diet and aerobic exercise alone to determine whether the addition of thoracic mobilization improves respiratory outcomes.

Participants will:

Be randomly assigned to either the intervention group or the control group. Receive an individualized low-carbohydrate diet and supervised aerobic exercise for 8 weeks.

Receive Mulligan thoracic mobilization in extension five times per week for 8 weeks if assigned to the intervention group.

Undergo assessments of ventilatory functions, chest wall expansion, functional capacity, and quality of life before and after the intervention.

Study Overview

• Status: Not yet recruiting
• Conditions: Central Obesity; Ventilatory Function
• Intervention / Treatment: Procedure: Mulligan Thoracic Mobilization; Behavioral: low carbohydrate; Behavioral: Aerobic Exercise

Detailed Description

The Challenge: Central Obesity and Respiratory Dysfunction

Central obesity is a growing global health concern that affects not only metabolic and cardiovascular health but also respiratory function. Excess accumulation of abdominal and visceral fat mechanically restricts chest wall movement, limits diaphragmatic excursion, and reduces lung volumes, leading to impaired ventilatory function and decreased chest wall expansion. These respiratory limitations can contribute to dyspnea, reduced exercise tolerance, and poorer quality of life. Although weight loss through dietary modification and aerobic exercise remains the cornerstone of obesity management, these approaches do not directly address the mechanical restrictions imposed on the thoracic cage. Therefore, additional physiotherapy interventions targeting thoracic mobility may provide further improvements in respiratory function.

The Goal of the Study

This study aims to determine whether adding Mulligan thoracic mobilization in extension to a standardized low-carbohydrate diet and aerobic exercise program provides greater improvements in ventilatory functions and chest wall expansion than diet and exercise alone in adults with central obesity. The study will also investigate whether this intervention improves functional exercise capacity and health-related quality of life.

How the Study Works

The study will involve 60 adult males with central obesity who meet the study eligibility criteria. Participants will be randomly assigned into two equal groups:

The Mulligan Thoracic Mobilization Group: Participants will receive Mulligan thoracic mobilization in extension performed by a trained physiotherapist five times per week for eight weeks. The mobilization will be applied to the mid-thoracic spine (T6-T8) using the Mobilization with Movement (MWM) concept while participants perform thoracic extension combined with deep inspiration. In addition, participants will follow an individualized low-carbohydrate diet and participate in a supervised aerobic exercise program.

The Control Group: Participants will receive the same individualized low-carbohydrate diet and supervised aerobic exercise program without Mulligan thoracic mobilization.

Both groups will participate in the intervention program for 8 weeks, with regular monitoring to ensure adherence and participant safety.

What Is Being Measured?

To determine the effectiveness of the intervention, the study will evaluate several important clinical outcomes:

Ventilatory Functions: Pulmonary function will be assessed using spirometry by measuring Forced Vital Capacity (FVC), Forced Expiratory Volume in one second (FEV₁), the FEV₁/FVC ratio, and Maximum Voluntary Ventilation (MVV).

Chest Wall Expansion: Chest wall mobility will be measured using a non-elastic tape measure at the fourth intercostal space and at the xiphoid process during maximal inspiration and expiration.

Functional Capacity: The Six-Minute Walk Test (6MWT) will be used to assess participants' functional exercise capacity.

Health-Related Quality of Life: Participants will complete the 36-Item Short Form Health Survey (SF-36) to evaluate physical and mental aspects of quality of life.

Why This Matters

Respiratory impairment associated with central obesity is largely driven by mechanical restriction of the thorax, yet current obesity management strategies rarely address this component directly. By investigating the effects of Mulligan thoracic mobilization in extension, this study aims to identify a safe, non-invasive, and clinically practical physiotherapy intervention that can complement conventional weight management. If effective, this approach may improve respiratory mechanics, enhance chest wall mobility, increase functional capacity, and improve quality of life for adults with central obesity while expanding the evidence base for manual therapy in cardiopulmonary rehabilitation.

• Study Type: Interventional
• Enrollment (Estimated): 60
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Abd El-Rahman A Abd El-Monem; Phone Number: 00201124079292; Email: abdelrahmanayman199810@gmail.com
• Study Contact Backup: Name: Alaa N Abdelhameed; Phone Number: 00201061382864

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Males aged 25-35 years.

• Presence of central obesity, defined as:

  • Waist circumference ≥102 cm in males.
  • Waist-hip ratio (WHR) ≥0.90 in males.
• BMI from 30-39.9 kg/m².
• Willing to comply with conventional physiotherapy (diet and exercise) and mobilization programs.
• Medically stable individuals with a restrictive lung pattern (Normal FEV₁/FVC ratio and FVC < 80% of predicted).
• Low level physical activity (using the International Physical Activity Questionnaire-Short Version).
• Non-smokers.

Exclusion Criteria:

• Diagnosed COPD, asthma, or other chronic respiratory diseases.
• Recent thoracic spine or rib injury/surgery.
• Cardiovascular instability or uncontrolled hypertension.
• Contraindications to manual therapy (e.g., osteoporosis, rib fractures, or spinal tumors).
• Participation in any structured weight loss program or exercise regimen in the past 6 months.
• History of bariatric surgery (e.g., gastric sleeve, gastric bypass).
• Use of medications that affect body weight or metabolism (e.g., corticosteroids, antipsychotics, weight loss drugs).
• Neurological or musculoskeletal conditions that limit mobility or exercise participation and interfere with gait.
• Any acute respiratory infections in the past 6 weeks.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Mulligan Thoracic Mobilization; will receive Mulligan thoracic mobilization in extension five times per week for 8 weeks in addition to a standardized diet and aerobic exercise.	Procedure: Mulligan Thoracic Mobilization; Technique: Thoracic mobilization with movement (MWM) in extension performed by a trained physiotherapist.; Performed 5×/week.; Total program duration: 8 weeks.; 3 sets × 10 repetitions per spinal level per session.; Hold time: thoracic extension maintained for approximately 6 seconds at the end of the movement.; Participant position: sitting at the edge of the treatment table with hands behind the neck.; Therapist technique: mobilizing force applied using the ulnar border of the hand over the spinous process in a cephalic-anterior direction.; Movement performed: deep inspiration combined with thoracic extension during the mobilization.; Target levels: Mid-thoracic region (T6-T8).; Session duration: The session duration was based on three sets of ten repetitions per spinal level, with each repetition held for approximately 6 seconds. A 30-second rest interval was provided between sets, resulting in an effective application time of about 4-5 minutes per level.; Behavioral: low carbohydrate; Standardized low-carbohydrate dietary program administered for 8 weeks.; Behavioral: Aerobic Exercise; Moderate-intensity aerobic exercise program for 8 weeks, 5 sessions per week, at 55-69% HRmax or Borg RPE 12-14, progressing from 30 to 45 minutes per session.
Active Comparator: low carbohydrate and Aerobic Exercises; will receive standardized diet and aerobic exercise.	Behavioral: low carbohydrate; Standardized low-carbohydrate dietary program administered for 8 weeks.; Behavioral: Aerobic Exercise; Moderate-intensity aerobic exercise program for 8 weeks, 5 sessions per week, at 55-69% HRmax or Borg RPE 12-14, progressing from 30 to 45 minutes per session.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Forced Vital Capacity	Measured in liters using spirometry.	Baseline (pre-intervention) and at the end of the 8-week training period (post-intervention).
Forced Expiratory Volume in One Second	Measured in liters using spirometry.	Baseline (pre-intervention) and at the end of the 8-week training period (post-intervention).
Ratio of Forced Expiratory Volume in One Second to Forced Vital Capacity	Measured as a percentage using spirometry.	Baseline (pre-intervention) and at the end of the 8-week training period (post-intervention).
Maximum Voluntary Ventilation	Measured in liters per minute using spirometry.	Baseline (pre-intervention) and at the end of the 8-week training period (post-intervention).
Chest Wall Expansion at the Fourth Intercostal Space	Chest wall expansion measured in centimeters using a non-elastic tape measure at the fourth intercostal space.	Baseline (pre-intervention) and at the end of the 8-week training period (post-intervention).
Chest Wall Expansion at the Xiphoid Process Level	Chest wall expansion measured in centimeters using a non-elastic tape measure at the level of the xiphoid process.	Baseline (pre-intervention) and at the end of the 8-week training period (post-intervention).

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Functional capacity	assessed by 6-Minute Walk Test (6MWT)	Baseline (pre-intervention) and at the end of the 8-week training period (post-intervention).
Change in Health-Related Quality of Life	using 36 Item Short Form Health Survey (SF 36) Health-related quality of life will be measured using the 36-Item Short Form Health Survey (SF-36). Scores for each domain and the Physical Component Summary (PCS) and Mental Component Summary (MCS) range from 0 to 100. Higher scores indicate better heal	Baseline (pre-intervention) and at the end of the 8-week training period (post-intervention).

Collaborators and Investigators

• Sponsor: Cairo University
• Investigators: Study Chair: Mona A Abdelwahab, Assistant Prof, Cairo University; Study Director: Shaimaa T Mohamed, Lecturer, Cairo University

Study record dates

Study Major Dates

• Study Start (Estimated): June 25, 2026
• Primary Completion (Estimated): December 15, 2026
• Study Completion (Estimated): February 10, 2027

Study Registration Dates

• First Submitted: July 14, 2026
• First Submitted That Met QC Criteria: July 17, 2026
• First Posted (Actual): July 21, 2026

Study Record Updates

• Last Update Posted (Actual): July 21, 2026
• Last Update Submitted That Met QC Criteria: July 17, 2026
• Last Verified: July 1, 2026

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Nutrition Disorders; Overnutrition; Body Weight; Overweight; Obesity; Pathological Conditions, Signs and Symptoms; Nutritional and Metabolic Diseases; Signs and Symptoms; Obesity, Abdominal; Motor Activity; Movement; Musculoskeletal Physiological Phenomena; Musculoskeletal and Neural Physiological Phenomena; Exercise
• Other Study ID Numbers: CU-AA-19052026

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: Individual participant data will not be shared to maintain participant privacy and strictly adhere to confidentiality agreements.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No