Short term effects of manual chest therapy on heart function after exercise in people with chronic obstructive pulmonary disease

INTERVENTION: Intervention1: Manual Therapy and Breathing Exercises: Thoracic Joint Mobilization PA glide. Technique: Grade II to III posteroanterior PA mobilization applied over thoracic segments T2 T8. Patient Position The patient lies prone face down on the treatment table. A pillow may be placed under the chest or abdomen for comfort. Therapist Position The therapist stands beside the patient at the level of the thoracic spine. Hand Placement The therapist places the heel of the hand over the spinous process of the thoracic vertebra. A gentle pressure is applied from posterior to anterior direction from back toward the front of the chest. The pressure is applied rhythmically in oscillatory movements. 30 seconds per segment 3 sets per segment 30 second rest between sets Maitland mobilisation will be applied 3 sessions per week for 2 weeks. Pulmonary rehabilitation Under this breathing retraining exercise will be given Breathing retraining exercises Diaphragmatic Breathing Abdominal Breathing Pursed Lip Breathing Thoracic Expansion Exercises Paced Breathing During Activity Relaxation Breathing The duration will be for 2 weeks. Control Intervention1: Conventional Physiotherapy: Conventional physiotherapy like breathing exercises expiratory exercises and airway clearance technique, postural drainage is given to group B Individuals CONDITION: Health Condition 1: J449‐ Chronic obstructive pulmonary disease, unspecified PRIMARY OUTCOME: Resting heart rate ; Resting Blood Pressure ; 6‐minute walk test ; Heart rate recovery at 1min ; Borg scale ; Chronic Obstructive Pulmonary Disease assessment test scoreTimepoint: At Baseline and at 2 Weeks Post Intervention SECONDARY OUTCOME: NILTimepoint: NIL INCLUSION CRITERIA: Diagnosed with stable Chronic Obstructive Pulmonary Disease classified as GOLD stage II or III by pulmonologist or general practitioner. Age between 40 to 75 years All genders Clinically stable with no acute exacerbation in past 4 weeks. Able to walk independently without assistive devices and perform the 6‐Minute Walk Test Willing to participate and provide written informed consent.