{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T02:47:25Z","timestamp":1792205245877,"version":"4.4.0"},"reference-count":50,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2020,9,6]],"date-time":"2020-09-06T00:00:00Z","timestamp":1599350400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Background: Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality worldwide. Hyperinflation of the lungs leads to a remodeling of the inspiratory muscles that causes postural deformities and more labored breathing. Postural changes include elevated, protracted, or abducted scapulae with medially rotated humerus, and kyphosis that leads to further tightening of respiratory muscles. As the severity of the disease progresses, use of the upper limbs for functional tasks becomes difficult due to muscle stiffness. There are various studies that suggest different rehabilitation programs for COPD patients; however, to the best of our knowledge none recommends passive stretching techniques. The aim of this study was to assess the effect of respiratory muscle passive stretching on chest expansion and 6-min walk distance (6MWD) in patients with moderate to severe COPD. Methods: Thirty patients were divided into two groups, experimental (n = 15) and control (n = 15). The experimental group received a hot pack followed by stretching of the respiratory muscles and relaxed passive movements of the shoulder joints. The control group received a hot pack followed by relaxed passive movements of the shoulder joints. Results: In the control group, there was no difference in chest expansion at the levels of both the axilla and the xiphisternum or in 6MWD between baseline and post treatment (p &gt; 0.05). In the experimental group, chest expansion at the level of the axilla (p &lt; 0.05) and 6MWD (p &lt; 0.001) were significantly higher post treatment, while there was no difference in chest expansion at the level of the xiphisternum (p &gt; 0.05). A comparison between control and experimental groups showed that chest expansion at the level of the axilla (p &lt; 0.05) and 6MWD (p &lt; 0.01) were significantly higher in the experimental group, while there was no difference in chest expansion at the level of the xiphisternum (p &gt; 0.05). Conclusions: Although COPD is an irreversible disease, results of this study indicate that passive stretching of respiratory muscles can clinically improve the condition of such patients, especially in terms of chest expansion and 6MWD. Given the good effects of muscle stretching and the fact that such an exercise is harmless, clinicians and physiotherapists should consider including passive stretching of respiratory muscles in the rehabilitation plan of COPD patients.<\/jats:p>","DOI":"10.3390\/ijerph17186480","type":"journal-article","created":{"date-parts":[[2020,9,6]],"date-time":"2020-09-06T23:12:49Z","timestamp":1599433969000},"page":"6480","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":24,"title":["Effect of Passive Stretching of Respiratory Muscles on Chest Expansion and 6-Minute Walk Distance in COPD Patients"],"prefix":"10.3390","volume":"17","author":[{"given":"Asma","family":"Rehman","sequence":"first","affiliation":[{"name":"Al Hosn One Day Surgery Center LLC, Al Sahel Tower Building, Post Box 37384, Abu Dhabi, UAE"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jyoti","family":"Ganai","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Sciences, Jamia Hamdard, New Delhi 110062, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajeev","family":"Aggarwal","sequence":"additional","affiliation":[{"name":"Neuro-Physiotherapy Unit, NSC, All India Institute of Medical Sciences, New Delhi 110029, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmad H.","family":"Alghadir","sequence":"additional","affiliation":[{"name":"Rehabilitation Research Chair, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0504-6863","authenticated-orcid":false,"given":"Zaheen A.","family":"Iqbal","sequence":"additional","affiliation":[{"name":"Rehabilitation Research Chair, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,9,6]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"4S","DOI":"10.1378\/chest.06-2418","article-title":"Pulmonary Rehabilitation: Joint ACCP\/AACVPR Evidence-Based Clinical Practice Guidelines","volume":"131","author":"Ries","year":"2007","journal-title":"Chest"},{"key":"ref_2","unstructured":"Alwan, A. (2011). Global Status Report on Noncommunicable Diseases 2010, World Health Organization."},{"key":"ref_3","first-page":"23","article-title":"A multicentric study on epidemiology of chronic obstructive pulmonary disease and its relationship with tobacco smoking and environmental tobacco smoke exposure","volume":"48","author":"Jindal","year":"2006","journal-title":"Indian J. Chest Dis. Allied Sci."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1270","DOI":"10.5588\/ijtld.12.0005","article-title":"Indian study on epidemiology of asthma, respiratory symptoms and chronic bronchitis in adults (INSEARCH)","volume":"16","author":"Jindal","year":"2012","journal-title":"Int. J. Tuberc. Lung Dis."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e015211","DOI":"10.1136\/bmjopen-2016-015211","article-title":"A cross-sectional study on prevalence of chronic obstructive pulmonary disease (COPD) in India: Rationale and methods","volume":"7","author":"Rajkumar","year":"2017","journal-title":"BMJ Open"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1081\/COPD-57598","article-title":"The airway pathophysiology of COPD: Implications for treatment","volume":"2","year":"2005","journal-title":"COPD J. Chronic Obstr. Pulm. Dis."},{"key":"ref_7","first-page":"324","article-title":"Mucus pathophysiology in COPD: Differences to asthma, and pharmacotherapy","volume":"55","author":"Rogers","year":"2000","journal-title":"Monaldi Arch. Chest Dis."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"613","DOI":"10.1016\/S0140-6736(04)16855-4","article-title":"Burden and clinical features of chronic obstructive pulmonary disease (COPD)","volume":"364","author":"Pauwels","year":"2004","journal-title":"Lancet"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1398","DOI":"10.1183\/09031936.95.08081398","article-title":"Optimal assessment and management of chronic obstructive pulmonary disease (COPD)","volume":"8","author":"Siafakas","year":"1995","journal-title":"Eur. Respir. J."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2884","DOI":"10.1183\/09031936.97.10122884","article-title":"Exercise training in COPD patients: The basic questions","volume":"10","author":"Gosselink","year":"1997","journal-title":"Eur. Respir. J."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"976","DOI":"10.1164\/ajrccm.153.3.8630582","article-title":"Peripheral muscle weakness contributes to exercise limitation in COPD","volume":"153","author":"Gosselink","year":"1996","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2021","DOI":"10.1164\/ajrccm.152.6.8520771","article-title":"Muscle strength, symptom intensity, and exercise capacity in patients with cardiorespiratory disorders","volume":"152","author":"Hamilton","year":"1995","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_13","first-page":"798","article-title":"Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: National Heart, Lung, and Blood Institute and World Health Organization Global Initiative for Chronic Obstructive Lung Disease (GOLD): Executive summary","volume":"46","author":"Pauwels","year":"2001","journal-title":"Respir. Care"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"200","DOI":"10.1164\/rccm.200502-262OC","article-title":"Diaphragm Dysfunction in Chronic Obstructive Pulmonary Disease","volume":"172","author":"Ottenheijm","year":"2005","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1159\/000050478","article-title":"Pathogenesis and pathology of COPD","volume":"68","author":"Turato","year":"2001","journal-title":"Respiration"},{"key":"ref_16","first-page":"1233","article-title":"Postural control in chronic obstructive pulmonary disease: A systematic review","volume":"10","author":"Porto","year":"2015","journal-title":"Int. J. Chronic Obstr. Pulm. Dis."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"397","DOI":"10.2147\/COPD.S49491","article-title":"Quantitative assessment of walking time and postural change in patients with COPD using a new triaxial accelerometer system","volume":"8","author":"Kawagoshi","year":"2013","journal-title":"Int. J. Chronic Obstr. Pulm. Dis."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1103","DOI":"10.1016\/j.apmr.2007.11.033","article-title":"Muscle Stretching Technique Increases Vital Capacity and Range of Motion in Patients With Chronic Obstructive Pulmonary Disease","volume":"89","author":"Putt","year":"2008","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"155","DOI":"10.2147\/COPD.S2126","article-title":"Outpatient pulmonary rehabilitation in patients with chronic obstructive pulmonary disease","volume":"3","author":"Barakat","year":"2008","journal-title":"Int. J. Chronic Obstr. Pulm. Dis."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"523","DOI":"10.1183\/09031936.06.00124605","article-title":"Global burden of COPD: Systematic review and meta-analysis","volume":"28","author":"Halbert","year":"2006","journal-title":"Eur. Respir. J."},{"key":"ref_21","first-page":"157","article-title":"Respiratory muscle stretch gymnastics in patients with post coronary artery bypass grafting pain: Impact on respiratory muscle function, activity, mood and exercise capacity","volume":"49","author":"Aida","year":"2002","journal-title":"J. Med. Dent. Sci."},{"key":"ref_22","first-page":"179","article-title":"Effects of short-term pulmonary rehabilitation on exercise capacity and quality of life in patients with chronic obstructive pulmonary disease","volume":"54","author":"Miyahara","year":"2000","journal-title":"Acta Med. Okayama"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"126","DOI":"10.2169\/internalmedicine.38.126","article-title":"Immediate Effect of Respiratory Muscle Stretch Gymnastics and Diaphragmatic Breathing on Respiratory Pattern","volume":"38","author":"Ito","year":"1999","journal-title":"Intern. Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"2691","DOI":"10.2147\/COPD.S114548","article-title":"Effects of aerobic training combined with respiratory muscle stretching on the functional exercise capacity and thoracoabdominal kinematics in patients with COPD: A randomized and controlled trial","volume":"11","author":"Wada","year":"2016","journal-title":"Int. J. Chronic Obstr. Pulm. Dis."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"338","DOI":"10.1016\/j.jbmt.2008.11.004","article-title":"Acute clinical benefits of chest wall-stretching exercise on expired tidal volume, dyspnea and chest expansion in a patient with chronic obstructive pulmonary disease: A single case study","volume":"13","author":"Leelarungrayub","year":"2009","journal-title":"J. Bodyw. Mov. Ther."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1547","DOI":"10.1056\/NEJM199512073332307","article-title":"Pathophysiology of Dyspnea","volume":"333","author":"Manning","year":"1995","journal-title":"N. Engl. J. Med."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Sadlonov\u00e1, J., Osinova, D., Rozborilova, E., Osina, O., Novakova, E., and Sadlonova, V. (2017). Importance of GOLD Guidelines for Chronic Obstructive Pulmonary Disease. Adv. Exp. Med. Biol., 45\u201352.","DOI":"10.1007\/5584_2017_44"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"145","DOI":"10.2340\/16501977-0146","article-title":"Effects of deep and superficial heating in the management of frozen shoulder","volume":"40","author":"Leung","year":"2008","journal-title":"Acta Derm. Venereol."},{"key":"ref_29","first-page":"13","article-title":"Efeito do alongamento sobre a atividade dos m\u00fasculos inspirat\u00f3rios na DPOC","volume":"7","author":"Cunha","year":"2005","journal-title":"Sa\u00fade Rev."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.resp.2017.03.002","article-title":"Immediate effects of respiratory muscle stretching on chest wall kinematics and electromyography in COPD patients","volume":"242","author":"Pessoa","year":"2017","journal-title":"Respir. Physiol. Neurobiol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"679","DOI":"10.1590\/S1806-37132007000600011","article-title":"Effect of a muscle stretching program using the Global Postural Reeducation method on respiratory muscle strength and thoracoabdominal mobility of sedentary young males","volume":"33","author":"Moreno","year":"2008","journal-title":"J. Bras. Pneumol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"805","DOI":"10.2169\/internalmedicine.41.805","article-title":"Cross-over Comparison between Respiratory Muscle Stretch Gymnastics and Inspiratory Muscle Training","volume":"41","author":"Minoguchi","year":"2002","journal-title":"Intern. Med."},{"key":"ref_33","first-page":"25","article-title":"The acute effects of two passive stretch maneuvers on pectoralis minor length and scapular kinematics among collegiate swimmers","volume":"8","author":"Williams","year":"2013","journal-title":"Int. J. Sports Phys. Ther."},{"key":"ref_34","unstructured":"Vibekki, P. (1991). Chest mobilization and respiratory function. Respir. Care, 103\u2013119."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"552","DOI":"10.1016\/j.rmr.2013.11.009","article-title":"La kin\u00e9sith\u00e9rapie respiratoire du poumon profond. Bases m\u00e9caniques d\u2019un nouveau paradigme","volume":"31","author":"Postiaux","year":"2014","journal-title":"Rev. Des Mal. Respir."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1155\/2019\/6364376","article-title":"Comparison of Diaphragmatic Stretch Technique and Manual Diaphragm Release Technique on Diaphragmatic Excursion in Chronic Obstructive Pulmonary Disease: A Randomized Crossover Trial","volume":"2019","author":"Nair","year":"2019","journal-title":"Pulm. Med."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Chaitow, L. (2002). Osteopathic Assessment and Treatment of Thoracic and Respiratory Dysfunction. Multidiscip. Approaches Breath. Pattern Disord.","DOI":"10.1016\/B978-044307053-2.50010-1"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"38","DOI":"10.3389\/fnbot.2018.00038","article-title":"Design and Evaluation of Passive Shoulder Joint Tracking Module for Upper-Limb Rehabilitation Robots","volume":"12","author":"Lee","year":"2018","journal-title":"Front. Neurorobot."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1136\/ard.31.1.1","article-title":"An objective clinical study of chest expansion","volume":"31","author":"Moll","year":"1972","journal-title":"Ann. Rheum. Dis."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1155\/2019\/5175949","article-title":"Reliability of Chest Wall Mobility and Its Correlation with Lung Functions in Healthy Nonsmokers, Healthy Smokers, and Patients with COPD","volume":"2019","author":"Reddy","year":"2019","journal-title":"Can. Respir. J."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1395","DOI":"10.1164\/ajrccm.163.6.2003172","article-title":"Inspiratory Capacity, Dynamic Hyperinflation, Breathlessness, and Exercise Performance during the 6-Minute-Walk Test in Chronic Obstructive Pulmonary Disease","volume":"163","author":"Marin","year":"2001","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_42","unstructured":"Weiss, R.A. (, January September). Six minute walk test in severe COPD: Reliability and effect of walking course layout and length. Proceedings of the ACCP Conference."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1164\/rccm.201212-2191ED","article-title":"The return of the minimum clinically important difference for 6-minute-walk distance in chronic obstructive pulmonary disease","volume":"187","author":"Holland","year":"2013","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_44","first-page":"47","article-title":"Thoraco-Abdominal Motion in Chronic Obstructive Pulmonary-Disease","volume":"115","author":"Sharp","year":"1977","journal-title":"Am. Rev. Respir. Dis."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"574","DOI":"10.1148\/radiology.215.2.r00ma28574","article-title":"Diaphragm and Chest Wall: Assessment of the Inspiratory Pump with MR Imaging\u2014Preliminary Observations","volume":"215","author":"Cluzel","year":"2000","journal-title":"Radiology"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1394","DOI":"10.1016\/S0140-6736(94)90568-1","article-title":"Randomised controlled trial of respiratory rehabilitation","volume":"344","author":"Goldstein","year":"1994","journal-title":"Lancet"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1541","DOI":"10.1164\/ajrccm.155.5.9154855","article-title":"Physiologic benefits of exercise training in rehabilitation of patients with severe chronic obstructive pulmonary disease","volume":"155","author":"Casaburi","year":"1997","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"13","DOI":"10.5005\/ijcdas-56-1-13","article-title":"The effect of a short-term pulmonary rehabilitation on exercise capacity and quality of life in patients hospitalised with acute exacerbation of chronic obstructive pulmonary disease","volume":"56","author":"Ali","year":"2014","journal-title":"Indian J. Chest Dis. Allied Sci."},{"key":"ref_49","first-page":"1","article-title":"Effect of Different Head-Neck Postures on the Respiratory Function in Healthy Males","volume":"2018","author":"Zafar","year":"2018","journal-title":"BioMed Res. Int."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1183\/09059180.00000809","article-title":"A physiological model of patient-reported breathlessness during daily activities in COPD","volume":"18","author":"Jolley","year":"2009","journal-title":"Eur. Respir. Rev."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/17\/18\/6480\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T10:07:16Z","timestamp":1760177236000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/17\/18\/6480"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,9,6]]},"references-count":50,"journal-issue":{"issue":"18","published-online":{"date-parts":[[2020,9]]}},"alternative-id":["ijerph17186480"],"URL":"https:\/\/doi.org\/10.3390\/ijerph17186480","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,9,6]]}}}