Effect of thoracic exercises on Balance and Fall risk in people with COPD

INTERVENTION: Intervention1: Active Thoracic mobility exercises: Active thoracic mobility exercises aimed at improving thoracic mobility balance and reducing fall risk in individuals with stable chronic obstructive disease if patient is comfortable and able to perform the patient will be given half kg weight cuff for upper limb strengthening and weight will be progressed weekly by therapist balance training will be structured based on components of Mini Balance Evaluation System Test which will include sit to stand activities reaching tasks pertubation training narrow base standing tandem walking obstacle crossing and turning tasks participants will undergo intervention for a period of 4 weeks and will be telephonically monitored by therapist Control Intervention1: Pulmonary rehabilitation: breathing retraining exercises such as diaphragmatic breathing pursed lip breathing thoracic expansion exercises airway clearance techniques and balance training participants will undergo protocol for a period of 4 weeks and will be telephonically monitored by therapist CONDITION: PRIMARY OUTCOME: Balance and fall risk measured using MINI Balance Evaluation System TestTimepoint: Day 1 baseline and follow up after 1 month of discharge SECONDARY OUTCOME: Thoracic kyphosis measured using flexicurve ruler ; Pulmonary function test measured using FEV1 by FVC ; Functional capacity measured using 6 minute walk testTimepoint: Day 1 baseline & follow up after 1 month of discharge INCLUSION CRITERIA: Adults aged 40‐75 years CLinically diagnosed with Chronic Obstructive Pulmonary Disease according to global initiative for chronic obstructive lung disease GOLD guidelines by a pulmonologist or clinical practitioner GOLD stage II TO III who have balance impairment Clinically stable Able to understand and follow commands and instructions