Effects of Otago Exercise Program vs Circuit Training on Balance in Chronic Obstructive Pulmonary Disease Patients (COPD)

The Otago exercise group will practice the Otago exercise protocol which includes strength and balance exercises along with pulmonary rehabilitation.

• 3 times per week for 8 weeks.
• Each session will be of 60 minutes
• Total number of sessions: 24

1. Warm-up exercises. Chair March, Arm swings ( 30 second), Head movement, neck movement, back extension, trunk movement, ankle movement (repeat 5 times).

   Back of thigh stretch, calf stretch, (hold for 8 seconds).

2. Strengthening exercises Front knee strengthening, back knee strengthening, side hip strengthening (2 or more sets of 10 reps) Calf raises, toe raises (repeat this exercises 10 to 20 times)
3. Balance improvement exercises Knee bends, heel-toe standing, heel toes walking, one leg stand ( start with 5 sec move up to 10 sec) Side walk, heel walking, sit to stand, backwards walking, heel toes walking backwards, walking and turning around, stair walking (10 steps).
4. Cool-down session Back of thigh stretch, calf stretches ( 10 to 20 sec hold, 1 to 3 reps)

5. Pulmonary rehabilitation program

   • Daily breathing exercises (e.g. diaphragmatic, pursed lip breathing).
   • Stretch exercise for major respiratory muscles.

The Circuit training group will practice balance exercises including Stance exercise, Functional strength exercise, Transition exercise and Gait training along with pulmonary rehabilitation.

• 3 times per week for 8 weeks.
• Each session will be of 60 minutes
• Total number of sessions: 24

1. Functional strength exercises Heel raise, toe raise, walking on toes, step ups in all directions ( forward, backward and sideways) (2 sets and 8 reps)
2. Stance exercises Tandem, narrow, one leg stance, and stand on uneven surfaces with open eyes (each exercise 30 seconds) Tandem, narrow, one leg stance, and stand on uneven surfaces with eyes closed (each exercise 15seconds).

3. Transition exercises Sit to stand from chair with arms (10 reps) and then without arms support (5 reps).

   Sit on floor and stand up with assistance and then without assistance.

4. Gait training Walking tandem, sideway and backward with arm support. Walking tandem, sideway and backward without arm support Walking tandem, sideway and backward over obstacles

5. Pulmonary rehabilitation program

   • Daily breathing exercises (e.g. diaphragmatic, pursed lip breathing).
   • Stretch exercise for major respiratory muscles

The most commonly used disease-specific quality of life measure for COPD patients is the St. George's Respiratory Questionnaire (SGRQ). Disease-specific instrument designed to measure impact on overall health, daily life, and perceived well-being in patients with obstructive airways disease.. It is divided in two parts. Part I produces the Symptoms score, and Part 2 the Activity and Impacts scores. The reliability coefficient was 0.94 for the overall scale and 0.72 for "Symptoms", 0.89 for "Activity", and 0.89 for "Impacts" subscales.

A total score is calculated from 0 (no health impairment) to 100 (maximum health impairment) Changes in St. George Respiratory questionnaire for quality of life from baseline to 4th and after 8 weeks of intervention will be assessed.