COPD is a life-threatening public health problem that starts with shortness of breath,
continues with exacerbations, and the prognosis gradually worsens. In COPD patients,
respiratory functions decrease due to changes in the airways in the advanced stages of
the disease; dyspnea, cough, and sputum emerge as three important symptoms. Respiratory
function limitations and symptoms caused by the disease also cause physical and
psychological disorders such as peripheral muscle weakness, exercise intolerance,
decreased quality of life, depression, and anxiety in patients. Diaphragm dysfunction
also develops in COPD. In severe COPD, changes occur in the sarcomere length, enzyme
activity, and mitochondrial density of diaphragm muscle fibers. Recurrent COPD attacks
also negatively affect diaphragm dysfunction. Due to diaphragm dysfunction, patients'
exercise tolerance and daily living activities decrease even more after attacks; their
quality of life decreases. The aim of treatment and care in COPD is to prevent
progression, reduce symptoms, prevent and/or treat recurrent acute attacks, protect
respiratory functions in the long term and prevent functional decline, increase exercise
capacity, reduce complications and protect and increase quality of life. Since drug
therapy alone is insufficient to achieve these goals, rehabilitation practices should
also be a part of the treatment in addition to drug therapy.
Oxygen therapy, nutritional support, pulmonary rehabilitation (PR) approaches are also
among the supportive and palliative treatment methods. In the last twenty years, the
negative effects of systemic symptoms on the functions of patients in COPD patients have
accelerated the development and use of PR. The main goals of PR are to reduce symptoms,
bring the person's functional and emotional status to the best possible level, increase
participation in daily life and quality of life, and reduce health-related expenses by
reversing or stabilizing the systemic effects of the disease. PR has been shown to be the
most effective non-pharmacological intervention to improve health status in COPD
patients. The main component of PR programs is exercise; which includes aerobic exercise,
strengthening exercises, inspiratory muscle training, controlled breathing techniques,
bronchial hygiene techniques, stretching exercises, relaxation exercises, as well as
water exercises, pilates and yoga programs. There are also daily life activity practices
and assistive device training exercises.
Considering the weakness of peripheral muscle and diaphragm muscle strength in COPD
patients, alternative strengthening methods for these muscles are important. rPMS is a
physical therapy method based on the interaction between a high-intensity electromagnetic
field and the human body. The electromagnetic field is generated by a coil placed in the
applicator. Depending on the frequency of stimulation and the intensity of the
electromagnetic field, it has analgesic, muscle relaxant or muscle strengthening effects.
The rPMS method, which is one of the alternative treatment methods that strengthens the
diaphragm, does not require direct contact with the skin. Since it can be applied over
clothes, the patient does not need to undress or prepare the skin. It is not painful like
other invasive methods, so the patient's compliance will be higher and the possibility of
abandoning the treatment is less. The rPMS application is fast and easy to use, because
there is no need to connect a stimulating electrode to the patient.
In this study, it is planned to investigate the hypothesis that adding rPMS of the
diaphragm to the PR program in individuals with COPD would lead to more improvement in
exercise capacity, diaphragm muscle thickness, and consequently, symptoms.
In line with this hypothesis, the aim of the study was to evaluate the effectiveness of
repetitive peripheral magnetic stimulation (rPMS) to increase diaphragm strength in
addition to the PR program applied in COPD, and to investigate the effect of this method
on exercise capacity, diaphragm muscle thickness and symptoms.
This is a prospective, randomized, sham-controlled, single-blind, experimental study.
Patients who admitt to Ankara University Medical Faculty Hospital Physical Medicine and
Rehabilitation Clinic for PR and have stable COPD diagnosis will be invited to the study.
This study will be conducted within the scope of good clinical practices and written
informed consent forms will be obtained from all patients. The sociodemographic
information, smoking history, duration of COPD, presence of co-morbidities, regularly
used medications, and other medical history of the patients will be recorded. Patients
will be randomized into two groups. Both groups will receive 24 sessions of standard PR
programs. Intervention group will also receive repetitive peripheral magnetic stimulation
(rPMS) to strengthen the diaphragm muscle. Patients will be evaluated at baseline and at
the end of the program. The assessments will include cardiopulmonary exercise test (CPET)
for dynamic respiratory functions and VO2max and six-minute walk test to determine
functional exercise capacity, Saint George Respiratory Questionnaire (SGRQ) for health
specific quality of life, Transitional Dyspnea Index (TDI) measuring changes in shortness
of breath, Modified Medical Research Council (mMRC) Dyspnea Scale and diaphragm muscle
thickness measurement with ultrasonography.