The effectiveness of home-based balance training combined with a pulmonary rehabilitation (PR) in individuals with chronic obstructive pulmonary disease (COPD): a randomized controlled trial

INTERVENTION: The PR program will consist of four main components including breathing exercise and stretching exercise, strengthening exercise, endurance exercise, and self‐management education and psychological and social support, The intervention program in this group will consist of the home‐based PR program combined with balance exercise training. The balance training exercise consists of 10 balance exercises (described as below) which are modified from a previous study. It will take approximately 20 minutes. The participants will be advised to take a rest in any time if they experience dizziness, breathlessness while exercising and back to exercise again within 20 minutes. The exercise will be progressed by decreasing support and increasing repetition and holding time when the participants have achieved the target of the current level CONDITION: ‐Balance performance ‐Fall risk ; Balance performance ; Fall risk; Balance training ; COPD Balance performance ; Fall risk; Balance training ; COPD PRIMARY OUTCOME: Physiological Profile Assessment (PPA) [Timeframe before and after 8 weeks of intervention program points] Timed Up and Go test (TUG) [Timeframe before and after 8 weeks of intervention program second] SECONDARY OUTCOME: Activities‐specific Balance Confidence (ABC) [Timeframe before and after 8 weeks of intervention program percentage] COPD assessment test‐Thai version (CAT‐TH) [Timeframe before and after 8 weeks of intervention program point] Modified Medical Research Council Dyspnea Scale (mMRC) [Timeframe before and after 8 weeks of intervention program scale] Six Minutes Walk Test (6MWT) [Timeframe before and after 8 weeks of intervention program meter] The BODE index [Timeframe before and after 8 weeks of intervention program point] INCLUSION CRITERIA: ‐Having a diagnosis of COPD according to Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage II or III [i.e. ratio of forced expiratory volume in one second and force vital capacity (FEV1/FVC) < 70% and percentage predicted of forced expiratory volume in one second (%predictedFEV1) between 30 ‐ 79%]. ‐Able to walk with or without walking aids. ‐Having balance impairment assessed by TUG test (>11.2 seconds)